Our office understands the importance of protecting your personal health information. To help you understand how we are doing that, we have outlined here how our office is using and disclosing your information.

This office will collect, use and disclose personal health information about you for the following purposes:

to deliver safe and efficient patient care
to identify and to ensure continuous high quality service
to assess your health needs
to provide health care
to advise you of treatment options
to enable us to contact you
to establish and maintain communication with you
to offer and provide treatment, care and services in relationship to the oral and maxillofacial complex and dental care generally
to communicate with other treating health care providers, including specialists and general dentists who are the referring dentists and/or peripheral dentists
to allow us to maintain communication and contact with you to distribute health care information and to book and confirm appointments
to allow us to efficiently follow-up for treatment, care and billing
for teaching and demonstrating purposes on an anonymous basis
to complete and submit dental claims for third party adjudication and payment
to permit potential purchasers, practice brokers or advisors to evaluate the dental practice
to allow potential purchasers, practice brokers or advisors to conduct an audit in preparation for a practice sale
to deliver your charts and records to the dentist's insurance carrier to enable the insurance company to assess liability and quantify damages, if any
to prepare materials for the Health Professions Appeal and Review Board (HPARB)
to invoice for goods and services
to process credit card payments
to collect unpaid accounts
to assist this office to comply with all regulatory requirements
to comply generally with the law

By signing the consent section of this Patient Consent Form, you have agreed that you have given your informed consent to the collection, use and/or disclosure of your personal health information for the purposes that are listed. If a new purpose arises for the use and/or disclosure of your personal health information, we will seek your approval in advance.

You may withdraw your consent for use or disclosure of your personal health information at any time.