Patient Acknowledgement and Consent

Effective April 14, 2003, the new federal law known as the Health insurance Portability and Accountability Act of 1996 (HIPAA) requires that this office comply with certain rules regarding the maintenance of the privacy of your information that we have collected and will collect in the future.

To comply with one of HIPPAA’s requirements we are giving you a copy of our Notice of Privacy Practices. This Notice of Privacy Practices contains the information the HIPAA requires us to disclose regarding our privacy practices.

From time to time, it may be necessary for us to make disclosures of your information in connection with our treatment. For examples, we may make a referral to or consult with another dentist or other health care professional, provide a specimen to a laboratory for testing or otherwise make disclosures of your information in connection with providing or coordination your treatment.

Download a Copy Here