Information we collect

When you use our contact form, we collect the details you choose to give us: your name, email address, phone number (optional), whether you are a patient or a referring provider, and your message.

Like most websites, our hosting provider may also record basic technical information such as your browser type and the pages you visit, to keep the site secure and working well.

Please do not send medical information

Our website contact form is for appointment requests and general questions only. Please do not include symptoms, diagnoses, test results or other health details. For anything about your health, call the practice directly.

How we use your information

• To reply to your message or appointment request
• To help referring providers reach the right member of our team
• To keep our website secure and prevent spam

We do not sell your information or use it for advertising.

Who can see your information

Messages are seen only by practice staff who need them to respond. Our website host stores form messages on our behalf. We share information with others only when required by law.

Cookies

This website may use a small number of cookies needed for it to work and for basic visitor statistics. You can block or delete cookies in your browser settings.

Your choices

You can ask us to tell you what information we hold from the contact form, or ask us to correct or delete it.

Your medical records

This policy covers the website only. A real practice would also provide a separate Notice of Privacy Practices explaining how patient health information is protected.

Contact

Questions about this policy? Email hello@example.com or call (555) 010-0123.

Last updated: October 2026