HFHT Staff and Practice Staff Annual Privacy Pledge Form

Please complete and submit the form below. Your privacy training is not considered complete unless this form is submitted. 

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I am a.. *

• HFHT Employee
• Physician/ Practice Staff Member
• Student
• Volunteer

Practice Name (if you are a Practice Staff Member)

Email address of Practice Manager (if you are a Practice Staff Member)

First and Last Name: *

Which privacy training session did you complete? *

• HFHT Refresher Privacy Training (short video).
• HFHT Privacy Training Webinar (2 hours).

Date you attended training *

session a training

Email address (to send you a privacy training confirmation): *

Email

Confirm Email

Submit