Follow Us x

a !

.

Call Today 903-597-3331

  • Home
  • Our Team
    • Dr. Clyde
    • Dental Staff
  • Dentistry Services
    • Cleanings
    • Teeth Whitening
    • Night Guards
    • Dentures/Partials
    • Dental X-Rays
    • Fillings
    • Dental Crowns
    • Root Canals
    • Extractions
  • Patient Forms
    • New Patient Info. Sheet
    • HIPPA Notice of Privacy Practices
    • Patient Acknowledgement of Receipt of Notice of Privacy Practices
  • FAQ
    • General Cleaning Questions
    • Teeth Whitening Questions
    • Night Guard Questions
    • Dentures/Partials Questions
    • Dental X-Ray Questions
    • Dental Fillings Questions
    • Dental Crowns Questions
    • Root Canal Questions
    • Dental Extraction Questions
    • Bad Breath Questions
    • Advanced Dental Questions
  • Reviews
  • Contact Us
    • Like us on Facebook
    • E-mail Us
    • Hours/Location
Contact Us

Contact Info x

  • William R. Clyde D.D.S.
  • Phone: 903-597-3331
  • Fax: 903-597-9639

Patient Acknowledgement of Receipt of Notice of Privacy Practices

Please print off and fill out this form before your first appointment.

Open Form


707 Turtle Creek Dr.
Tyler, TX 75701

Phone: 903-597-3331
Fax: 903-597-9639

KC

Patient Forms

  • New Patient Info. Sheet
  • HIPPA Notice of Privacy Practices
  • Patient Acknowledgement of Receipt of Notice of Privacy Practices

Other Links

  • Privacy Policy Notice
  • About Us
  • FAQ
  • Reviews

  • Copyright © 2023 William R. Clyde D.D.S., all rights reserved.
  • 707 Turtle Creek Dr.,  Tyler, TX 75701   (903) 597-3331