Our Notice of Privacy Practices provides information about how we may use and disclose health information about you or as guardian to a minor. Be assured that all records are protected and secure.
 
You have the right to review our notice before signing a consent for diagnosis and / or treatment. As provided in our notice, the terms of our notice may change to reflect current policy or practice. If we change our notice, you may obtain a revised copy by contacting us at 24 Hour Dentist.

You have the right to request that we constrict how protected health information about you is used or disclosed for treatment, laboratory, payment, or healthcare operations. We are not required to agree to this restriction, but if we do, we are bound by our agreement.

You understand that photographs, videotapes, digital, or other images may be recorded to document your care and security; and that you consent to this. This includes but not limited to the treatment and waiting area. You understand that 24 Hour Dentist will retain the ownership rights to these photographs, videotapes, digital other images or casting, but that you will be allowed access to view them and obtain copies. You understand that your records and these images will be stored in a secure manner that will protect your privacy and that they will be kept for the time period required by law as outlined by 24 Hour Dentist policy.  Images that identify you will be released and/or used outside the office only upon written authorization from statures of law , your legal representative or you.

By signing our form, you consent to our use and disclosure of protected health information about you for treatment, payment, laboratory and health care operations.

You have the right to revoke this consent in writing, except when we have already made disclosures in reliance on your prior consent.

Thank You.