I am a patient of SkinMD, LLC.  I hereby acknowledge receipt of SkinMD, LLC's Notice of Privacy Practices.  The Notice of Privacy Practice provides detailed information about how the practice may use and disclose my confidential information.

I understand that SkinMD, LLC has reserved a right to change their privacy practices that are described in the Notice.  I also understand that a copy of any revised Notice will be provided to me or made available.

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