Cathy Weeg HIPPA Acknowlegement

Cathy Weeg, LPC

Counseling and Therapy Services

Notice of Privacy Practices and Clients Rights

Receipt and Acknowledgement of Notice
Client Name:
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I hereby acknowledge that I have received and have been given an opportunity to read a copy of Cathy Weeg’s Notice of Privacy Practices and Client Rights. I understand that if I have any questions regarding the notice of privacy rights, I can contact Cathy Weeg at (907)590-8384.

By typing your name below, you acknowledge having read a copy of Cathy Weeg’s Notice of Privacy Practices and Client Rights.
Consent:(Required)
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Signature of Client:(Required)

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