This notice describes how your medical information may be used and disclosed and how you can assess this information.

Download and complete, bring with you to the office when you have your appointment.

Necessary to file with your insurance (included in new patient information forms).

Patient Information Form Analysis Record Medical Concept

Michael P. Golden M.D. | 4100 West 15th Street, suite 212 Plano, Texas 75093 | Phone: 972 596 4121 • Fax: 972 596 9679