At our office, we are committed to protecting our patients’ personal information and ensuring it is used in a professional, confidential, and secure manner. The following outlines the types of information we collect, why we collect it, and when it may be disclosed. We collect, use, and disclose personal information only where permitted or required by law.

Contact Information

• We collect information such as your full name, home address, telephone numbers, and email address. This information is collected for purposes including:

• Opening and updating your patient file

• Contacting you regarding appointments, treatment, or follow-up care

• Sending correspondence related to our clinic and services

• Processing payments, including credit card transactions

• Submitting insurance claims or pre-authorizations to insurance companies or third-party health benefit providers

Medical / Dental History

We collect information regarding your medical and dental history, including your current and past health conditions, medications, family health history, and dental history. This information is collected to help us properly assess, diagnose, and provide appropriate treatment for you.

Your medical/dental information may be disclosed for the following purposes:

• To insurance companies or third-party benefit providers for claim submissions or treatment pre-authorizations on your behalf

• To other healthcare or dental providers, with your consent, for referrals, consultations, or second opinions regarding your treatment

Financial Information

We may collect financial information necessary for processing payments related to your treatment.

Future Use

In the event that this practice is considered for sale, qualified prospective purchasers may be granted limited access to patient information as part of the due diligence process. If this occurs, all reasonable steps will be taken to ensure your personal information remains protected and confidential.

Regulatory Requirements

The College of Denturists of Ontario regulates all Denturists in the Province of Ontario. As part of its regulatory responsibilities, the College may inspect office records and interview staff as permitted by law.

Consent

I hereby authorize and consent to the collection, use, and disclosure of my personal and health information for the purposes outlined above.