This Notice of Privacy Practices applies to the following organization. Schmidl Orthodontics 2937 Siskiyou Blvd #2, Medford OR 97504 254 Palm St. Ashland, OR 97520 ACKNOWLEDGEMENT OF RECEIPT OF THIS NOTICE:Name* First Last Signature of Patient or Personal Representative*Date* MM slash DD slash YYYY Privacy Official: Alex Winstead office@schmidlorthodontics.com 541-773-6600 CAPTCHA
