Consent for Personal Information

Protecting the privacy of our client information is very important to us. We vow to only utilize any personal information in a responsible and professional manner. We will only use and disclose personal information when permitted or required by law.

We collect information from our patients such as names, birthdates, home addresses and work addresses, home, work and cellphone numbers and e-mail addresses. This information is collectively referred to as ‘contact information.’

This contact information is collected and used for the following purposes:

• to open and update client files
• to invoice clients for dental services, to process payments and to collect unpaid accounts
• to process claims for payment to reimbursement from third-party health benefit providers and insurance companies.
• to send reminders to patients regarding annual oral health exams or outstanding treatment.

Contact information is disclosed to third-party health benefit providers and insurance companies where the client has submitted a claim for reimbursement for payment of all or part of the cost of the dental treatment or has asked us to submit a claim on their behalf.

We will also collect information from our clients about their health history, physical condition, and dental history. This information is collectively referred to as ‘medical information’. Clients’ medical information is collected and used for the purpose of diagnosing dental conditions and providing dental treatment.

This medical information is disclosed to:

• other dentists or dental providers where we are seeking a second opinion and the client has consented to us obtaining the second opinion.
• other dentists or dental providers, where they have asked us, with the consent of the client, to provide a second opinion.
• other health care professionals such as physiciansif the client, with their consent, has been referred to us from another health professional for either a second opinion or treatment.