A Notice to our Patients about our Privacy Policy and Information Practices


Dr and her staff are committed to maintaining the confidentiality of your personal, financial and health information supplied to us.  State and Federal Laws require us to inform you of our policy and practices as long as we provide service to you.


How we protect your personal information: We authorize individuals to access your personal information only to the extent necessary to conduct our business of serving you, such as making and confirming dental appointments, submitting insurance claims, securing insurance benefit information, and submitting applications for third party financing per your request.  We take steps to secure our building, patient files, and electronic systems from unauthorized access.  Our employees are trained regarding confidentiality and are held to strict Office Policy and Procedures regarding your personal and health information, both written and verbal. All employees are subject to discipline if they are found to be in violation of these procedures.


Information we collect:

Examples of your personal information would include: name, social security number, address, telephone numbers, employment, medical history, health records and claims information.


Information we may share:

We may share your personal or health information with other third parties with or without prior authorization for our normal business functions. Examples would be:


Patient rights:

We honor your right to request access to your personal information.  To do so, you must submit a written request describing the information you are requesting. There may or may not be a charge associated with this request to accommodate staff time. If we are able to locate and retrieve the information within 30 days of your request we will:


If you request a correction, amendment or deletion of personal information, we will correct, amend or delete your personal information or we will notify you of our refusal. You may submit a statement telling us what you believe to be relevant or fair information and the reasons that you disagree with our decision. Your statements will be filed with your personal information.