METROPLEX PULMONARY & SLEEP CENTER, P.A
4833 Medical Center Drive, Suite 6B McKinney, Texas 75069
Phone: 972- 838-1892 Fax: 972-838-1896 or 972-954-6030
I acknowledge that Metroplex Pulmonary and Sleep Center provided me with a written copy its
Notice of Privacy Practices.
I also acknowledge that I have been afforded the opportunity to read the Notice of Privacy Practices
and ask questions.
Sleep and breathing disorders are extremely common in this country and affect daytime
wakefulness to different degree in each person. Obviously, each person must use his or her best
judgement to be safe during operating heavy machinery, behind the wheel or working at heights.
Furthermore, you should also be aware that sleep medications may cause daytime drowsiness as
well. Therefore, you should not expose yourself to others to avoid possible harm due to potential
For your protection we require that you have received this notice. Therefore, please sign below.