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Lake Mary / Orange City / Oviedo (407) 391-3344


Privacy Practice

 Notice of Privacy Practices 

On 2 Feet, LLC Notice of Privacy Practices provides information about how we may use and disclose protected health information about you. You have the right to review our notice before signing this form. As provided in our notice, the terms of our notice may change. If we change our notice, you may obtain a revised copy by contacting On 2 Feet, LLC. 


You have the right to request that we restrict how protected health information about you is used or disclosed for  treatment, payment or health care operations. We are not required to agree to this restriction, but if we do, we are bound by our agreement. 


By signing this form, you consent to our use and disclosure of protected health information about you for treatment, payment and health care operations as described in our notice. You have the right to revoke this consent in writing, except where we have already made disclosure in reliance on your prior consent.

AUTHORIZATION FOR RECEIVING MESSAGES AND AUTOMATED CALLS: I give On 2 Feet, LLC permission to contact me by  telephone at the telephone number or numbers I provided during the registration process, or at any time in the future, including wireless telephone numbers or other numbers that may result in charges to me. The Hospital and its agents may leave messages for me at these numbers and may send text messages or email communications using the email address or
addresses I provide. These voice messages and email and text communications may include information required by law (including debt collection laws) related to amounts I owe On 2 Feet, LLC as well as messages related to my continued care and treatment. 


I also understand On 2 Feet, LLC and its agents, including debt collection agencies, may use pre-recorded/artificial voice messages and/or use an automatic dialing devise (an autodialer) to deliver messages related to my account and amounts I may owe On 2 Feet, LLC. I also authorize the On 2 Feet, LLC and its agents to use the number or numbers provided for such pre-recorded or auto dial messages. If I want to limit these communications to a specific telephone number or numbers, I understand that I must request that only a designated number or numbers may be used for these purposes

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