Acknowledgement of Privacy Notice Form

The Acknowledgement of Receipt of Privacy Notice Form (Privacy Practices Form) is required for new patient registration.  It is a government-required form.  To complete this form, please click the link below:

 

https://cryptnsend.com/stfh/stfh.html

 

The form above refers to the below notice:

View our Notice of Privacy Practices

 

If you prefer a downloadable pdf version of this form, please go to the Forms page

Simple Traditions

Family Health PLLC

18423 FM 1488 Rd Suite C

Magnolia, TX 77354

281-259-7400

Office of:

Paul Dibble MD

Alyson Van Tiem PA-C

 

Traffic in Magnolia can be surprisingly heavy; plan plenty of time for travel when coming to our clinic. See  Driving Directions

We are moving soon!

 

We are scheduled to be in our new clinic 07 JUL

 

Our new address will be:

827 S Magnolia Blvd Ste 6

Magnolia, TX 77355

 

see directions

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We do not take insurance

We accept cash, check, credit/debit cards

See our Prices

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