Privacy of your personal information is an important part of our commitment to providing you with quality dental care. We understand the importance of protecting your personal information. We are committed to collecting, using, and disclosing your personal information responsibly. Storage, retention, and destruction of your personal information comply with existing legislation and privacy protection protocols put forward by the Newfoundland and Labrador Dental Board. With this consent form, we have outlined what our office is doing to ensure that only necessary information is collected. Upon signing, you are providing consent for collection and disclosure as outlined below.

We understand the importance of protecting your personal information. To help you understand how we are doing that, we have outlined here how our office is using and disclosing your personal information. We collect personal information to enable us to deliver safe and efficient patient care, to assess your health needs, and provide appropriate care and treatment options. Your personal information allows us to maintain communication with you directly and with other treating clinicians in relation to oral and maxillofacial dental care in general. It allows us to communicate with other treating health care providers, including but not limited to specialists and general dentists who are the referring dentists and/or peripheral dentists. This would include all documented note-taking, X-rays, CBCT scans, and any other information that may be of importance in the safe delivery of patient care. Your personal information provides us the ability to efficiently contact you for scheduling, treatment, and billing; to complete and submit dental claims for third-party adjudication and payment; to invoice for services rendered; collect payment and process credit card payments. In the event of an unpaid account, your personal consent allows us to take steps to collect on that account. This also assists this office in complying with all regulatory requirements and to comply generally with the law. By signing this Patient Consent Form, you have agreed that you have given your informed consent to the collection, use, and/or disclosure of your personal information for the purposes that have been listed.