• Acknowledgement Form


    I acknowledge that I have read and understand the information included in Dr. Korngold’s Office Policies and Informed Consent. I agree to abide by these office policies during our professional relationship. I also acknowledge that I have read and understand the information included in Dr. Korngold’s Notice of Privacy Practices. I have had the opportunity to discuss any concerns with Dr. Korngold and I consent to treatment.



A copy of this form will be emailed to you as well.

If you would rather print out, sign and bring this form to your first appointment, please download document here: Acknowledgement Form (PDF)