If you are at least 18 years old and would like to give another person (example: spouse, sibling, child, parent) permission to discuss your test results, appointment schedule, or treatment with Take 2 Healthcare staff, please fill out the information below.
If I choose to rescind permission for above person to discuss my health status and results, I understand that I must submit this request in writing to Take 2 Healthcare.
Van D. Merkle, DC, CCN, DACBN, DABCI
Tracey C. Merkle, MS
Andrew Dyer, DC, DABCA
Natalie Yahle, DC