HIPPA Privacy Notice

  • Our Legal Duty:

    We are required by law to protect the privacy of your medical information, provide you a notice about our privacy practices and follow these practices described in this notice. If you have questions or complaints, you may contact the Practice Manager at the office of Well Life.

    2 First Avenue Suite 215
    Peabody, MA 01960
    (978) 740-2300.

    Our notice of privacy practices provides information about how we may use and disclose protected health information about you. You have the right to review our notice before signing this acknowledgment. As provided in our notice, the terms of our notice may change. If we change our policy, you may obtain a revised copy by contacting Dr. Francis M. Harte, MD.

    Complaints:

    If you think that your privacy rights have been violated, or if you disagree with a decision we made about the use or access to your records, you may contact the Practice Manager. You also may send a written complaint to the:

    U.S. Department of Health and Human Services
    200 Independent Avenue S.W.
    Washington D.C. 20201.

    The telephone number is (877) 696-6775

  • Nothing, except the above mentioned, will be released without your written permission. This will include family, or request for records by outside sources.

  • Please use your mouse, touch-pad or finger (if on a touch device) to sign before submitting the registration form.
  • We only require your email in order to send you a copy of this form for your records. We recommend you bring a copy with you on your first visit.