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Privacy and Sharing of Information I authorize Harmony health and Wellness, LLC and its associated health professionals to collect my personal and medical information as documented above while under their care. In addition, I authorize the clinic and its associated health professionals to communicate with my family doctor and/or referring doctor as deemed necessary for my beneficial treatment. I also understand that my personal and medical information is confidential and will only be disclosed to third parties with my permission according to HIPPA requirements. I intend this consent form to cover the entire course of treatment for my present condition and for any future condition(s) for which I seek treatment and I may ask my provider for a more detailed explanation.