HIPAA Release I have read and been offered a copy of the privacy practices for Chet A. Hymas, DMD PLLC. Date: Relationship to patient: Self Parent Guardian Legal Representative I give my consent to allow the following person(s) access to my dental/medical information: Name Relationship Initials Submit Form Your request has been sent -- we will be in contact with you shortly. There was an error! Please phone our office.
