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:


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

827 S Magnolia Blvd Suite 6

Magnolia, TX 77355


Office of:

Paul Dibble MD

Pamela Johnson MD

September marks our 8 year anniversary!!


Thank you all for your support.  We look forward to continuing to serve our patients and community.

Print Print | Sitemap Recommend this page Recommend this page
© Simple Traditions Family Health PLLC

This website was created using 1&1 IONOS MyWebsite.