HIPAA Policy Form

Please download this form, fill it out and bring to your appointment. Or, you may fax it to 214.442.7075

» CLICK HERE for our HIPAA Policy Form

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Office: 214.442.7050
Fax: 214.442.7075

3301 E. Renner Rd
Suite 100
Richardson, TX 75082

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Hours
Monday - Friday
8 - 5


Elizabeth Jekot MD Breast Imaging Center
3301 E. Renner Rd, Suite 100
Richardson, TX 75082

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