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FORMS, CONSENTS & RESOURCES

Man in Suit Signing
FOR PATIENTS:
FOR DOWNLOAD:
FOR CLINICAL STUDENTS:

LIGHTHOUSE's Confidentiality & Non-Disclosure Agreement (CNDA) and Patient Privacy (HIPAA) for Non-Affiliate, Non-Employee participating in Internship, Residency/Fellowship Rotation, Preceptorship, Externship, Shadowing Program, and Volunteering:

OUR CLINIC IS NOT A CRISIS CENTER AND DOES NOT MANAGE ACUTE CRISIS

IN CASE OF EMERGENCY

  • If experiencing a life-threatening EMERGENCY, please dial 9-1-1

  • Central Arizona Crisis Line: (602) 222-9444 or (800) 631-1314

  • National Suicide Prevention Lifeline: (800) 273-8255 (TALK) or dial 9-8-8

  • Teen Lifeline (www.teenlifeline.org): (602) 248-8336 (TEEN)

Clinical Student HIPAA Agreement
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