PATIENT LINKS

Your signature indicates that SouthBridge may release information to your insurance provider, permitting us to bill for services rendered.

It is also an acknowledgement of our privacy practices.

Online Signature Form

Request a copy of your SouthBridge patient records.

Online document request applies to individual patients or their personal representative only (Generally, a personal representative is a person with authority under State law to make health care decisions for the individual).  In compliance with 45 CFR 164.524(a)(1)(ii) information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding is excluded from the Right of Access  

Online Record Release

SouthBridge Privacy Practices