Tell Us About Your Viverant Experience
Everyone follows their own path from pain, tightness and weakness to health, wellness and fitness. We’d like to hear more about yours. Please tell us a little bit about your experiences with Viverant Physical Therapy.
Your answers will be completely confidential unless you give us permission to quote you. Everything you share with us will help us improve what we do and better serve you and our future patients.
Unless I otherwise specify, the information described above may be disclosed to i-Health’s vendors and/or to the general public in connection with publicizing and promoting i-Health, including in print publications, multimedia presentations, television advertising, on websites and social media sites, in any other distribution media, and educational materials.
I understand that i-Health will not condition treatment, payment, enrollment or eligibility for benefits on whether I sign this authorization form.
I understand that I may revoke this authorization by sending a written request for revocation to i-Health’s Privacy Officer. If I revoke this authorization, i-Health will no longer use or disclose my medical information for the reasons covered by this authorization, except to the extent it has already relied upon this authorization. I understand that when i-Health discloses information pursuant to this authorization, the information may no longer be protected by federal or state privacy rules and may be subject to re-disclosure by the recipient of the information.
This authorization shall not expire unless requested by Patient or Patient Representative.
Viverant Physical Therapy is an operating division of Infinite Health Collaborative (i-Health). Infinite Health Collaborative (i-Health) is a group of local medical practices, independently owned and led by its physicians, with operating divisions representing several areas of expertise. Visit i-Health.com to view the practices that are a part of i-Health.