This is to acknowledge that I reviewed the document entitled "Privacy Practices". I understand that this Acknowledgement will be retained in my records for a period of six (6) years. Stephanie R. Baron, Ph.D. 10444 Santa Monica Blvd. Suite 302 Los Angeles, CA 90025 PATIENT ACKNOWLEDGEMENT OF RECEIPT OF: NOTICE OF PRIVACY PRACTICES Name Date By entering the following code and by submitting this online form, I hereby declare that I have read and accepted all information contained in the NOTICE OF PRIVACY PRACTICES Acceptance Code *