It is our goal to protect the privacy of your health information. If you would like us to speak with a spouse, child, parent, friend or loved one about your test results, health information or financial matters, or you would like to have them accompany you during an appointment, HIPAA law requires that you complete a consent form.

Click on the link below to access the Patient Authorization form. You will be able to customize your preferences by checking the appropriate choices. If you have previously signed a release, it is time to renew it.

Click Here to Download the Patient Authorization Form

NOTE: This document is interactive, including a digital signature. For the interactive features to work, download the document to your computer, open with Adobe Reader or Acrobat. If you open it in your browser, these features may not work correctly.

Please return this form on your next visit. If you would like to return it by mail, please send mail it to:

Attn: Office Manager
Kaplan Center for Integrative Medicine
6829 Elm St., Suite 300
McLean, VA 22101

IMPORTANT: Do not email this document back to us as it is not a secure method of communication. If you have a patient portal account and a scanner, this form can be scanned and sent to us via the patient portal.