Patient Request for Confidential Communications

Alexandra Buwalda, DPT assumes that you may be contacted by telephone at your home and at your work, and in writing at your home, unless you instruct us otherwise.

Under HIPAA, you have the right to request that communications with you be confidential and by means of your selection. We are obligated to honor it, except if an emergency arises.

I wish to be contacted as follows (check all that apply):