Receipt Of HIPAA Privacy Practices

The MCPST Receipt of Health Insurance Portability and Accountability Act of 1996 (HIPAA) Notice of Privacy Practices Form acknowledges that you have received and understand the MCPST HIPAA Privacy Practices form which describes legal use and disclosure of health information.

You can download a printable copy of MCPST Receipt of Privacy Practices form.

Please visit our MCPST Forms page for information about  how to use this form if you are a new client.

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Midwest Center for Psychotherapy & Sex Therapy · 6300 University Avenue, Suite 125 · Middleton, WI 53562 · (P) 608-237-8000 · (F) 608-237-8005