Skip to main content
Home » Insurance Signature Form

Insurance Signature Form

  • Urban Eyes, Inc. HIPAA Patient Record of Disclosures

  • In general. the Health Insurance Portability and Accountability Act (HIPAA) gives individuals the right to request a restriction on uses and disclosures of their protected health information (PHI). The individual is also provided the right to request confidential communication or that a communication of PHI be made by alternative means, such as sending correspondence to the individual's office instead of home.

    The privacy rule requires that healthcare providers take reasonable steps to insure that your privacy is protected. Urban Eyes, Inc. is HIPAA compliant and will not disclose any private information unless specifically needed and approved by the patient.

  • MM slash DD slash YYYY

Urban Eyes Inc Spring, Texas


Closed: Wednesday, November 23th - Friday, November 25th

Closed: Saturday, December 24th - Monday, December 26th

Closed: Sunday, January 1st & Monday, January 2nd

Happy Holidays From Urban Eyes!