We are committed to protecting the privacy of your personal information and using all personal information in a responsible and professional manner.
PERSONAL INFORMATION COLLECTED
• Names, residence and business addresses, email addresses, cell, residence and business telephone numbers.
• Financial information such as dental insurance information, third party dental provider information and payment transaction slips if you are paying by credit or debit card.
• Pertinent medical and dental histories and clinical photographs.
HOW WE USE THE INFORMATION COLLECTED
Personal information is used to open and update patient files, to contact patients for follow-up treatment, process dental benefit claims and to send patients informational material about our practice.
Financial information is used to process payments for our services, to process claims for third party providers and dental insurance companies and collect unpaid accounts.
Medical and dental information is used to diagnose and safely and appropriately treat dental conditions.
WHOM WE MIGHT DISCLOSE PERSONAL INFORMATION TO
Insurance companies and third party dental providers for approval, re-imbursement or payment of dental services.
To other dentists, dental offices or health professionals where we are seeking a second opinion and the patient has consented to obtaining a second opinion or where we are referring the patient for diagnosis and treatment.
To other dentists, dental offices or health professionals who have asked us, with the consent of the patient, for a second opinion or who have referred the patient to our office for diagnosis and treatment.
To legal firms or other parties with the consent of the patient. To the Alberta Dental Association and College, the regulatory board of dentists, who may inspect our records and interview our staff as part of its regulatory activities in the public interest.
If we consider selling all or part of our dental practice the potential qualified purchaser may be granted access to patient information as part of the due diligence process to verify information necessary for the potential sale. If this occurs we will take steps to ensure the non-disclosure of your personal information.
I consent to the collection, use and disclosure of my personal information as indicated above.