Everything you may be asked to read, sign, or return — in one place, straight from the source.
Altavida Gynecology is part of Privia Medical Group, and these forms are maintained by Privia for all of its care centers.
Each link below opens Privia's own copy rather than a version stored on this site, so what you open is always the current one. If you'd rather we mail or hand you a printed copy, just let us know.
Every form is bilingual — English and Spanish are in the same PDF. Cada formulario incluye la versión en español.
Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.
Open the formAllows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.
Open the formAll patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility.
Open the formPatients are encouraged to complete and return the Preferred Contacts Form but it is not required.
Open the formThis form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.
Open the formFree language assistance and auxiliary aids are available to patients who need them. This notice explains what is offered and how to request it.
Read the noticeCall the office and a real person will walk you through it — before you sign anything.
No membership required for your first visit. Bring your questions — we'll handle the paperwork together.
Proud to be part of Privia Medical Group
