Notice of Privacy Policy
Please Read This Notice Carefully
THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED, AS WELL AS HOW YOU CAN ACCESS THIS INFORMATION. PLEASE READ IT CAREFULLY.
Protecting your personal information is important to us. We handle your information in accordance with Alberta law and only collect, use, or disclose it when permitted or required by applicable legislation.
Contact Information We Collect
We collect information about our patients, which includes:
- Names
- Home addresses
- Home telephone numbers
- Work addresses
- Work telephone numbers
- Forwarding contact numbers and addresses in case of relocation
- E-mail addresses
- Alberta Health Care Numbers
- Dental Insurance Information
(Collectively referred to as “Contact Information.”)
How Contact Information Is Used
Contact information is collected and used to:
- Open and update patient files and assess your health needs.
- Invoice patients for dental services.
- Process credit card payments.
- Collect unpaid accounts.
- Process claims for payment or reimbursement from third parties.
- Send reminders concerning the need for further dental examinations or treatment.
- Send informational material about our dental office.
Disclosure of Contact Information
Your Contact Information may be shared with third-party health benefit providers or insurance companies when you submit a claim for reimbursement or payment of all or part of your dental treatment, or when you ask us to submit a claim on your behalf.
By providing your e-mail address, you consent to receiving communications from our office by e-mail through either automated or manual methods.
For quality assurance purposes, telephone calls with our office may be monitored and/or recorded.
Financial Information
Financial Information may be collected to help arrange payment for the dental services you receive.
Medical Information We Collect
We collect information from our patients about:
- Health history
- Family health history
- Physical condition
- Existing dental treatments
(Collectively referred to as “Medical Information.”)
How Medical Information Is Used
Patients’ Medical Information is collected and used to help diagnose dental conditions and provide appropriate dental treatment.
Disclosure of Medical Information
Medical information may be disclosed in the following situations:
- To third-party health benefit providers or insurance companies when a patient submits a claim for reimbursement or payment of all or part of the cost of dental treatment, or requests that we submit a claim on their behalf.
- To other dentists, specialists, or healthcare professionals with the patient’s implicit or explicit consent, or when the patient is involved in a referral to or from our dental offic
Sale of the Office
If we consider selling all or part of our dental office, qualified prospective purchasers may be given limited access to patient information as part of the due diligence process to verify information relevant to the proposed sale.
Should this occur, appropriate measures will be taken to ensure that the prospective purchaser protects and safeguards all personal information.
Regulatory Requirements
Dentists are regulated by the Alberta Dental Association and College, which may review our records and interview our staff as part of its regulatory responsibilities carried out in the public interest.
Information may also be requested by other regulatory authorities and may also be disclosed in the event of litigation.
Protecting Your Privacy
Safeguarding your personal information is an important part of our commitment to providing quality dental care. We take appropriate steps to protect your privacy while collecting, using, and disclosing your information in accordance with applicable laws.
If we have reasonable grounds to suspect abuse or neglect, we may disclose your health information to the appropriate governmental authorities, as permitted or required by law
Questions or Requests
If you have any questions or concerns, need to obtain information, or need to transfer your records to another office, please contact our Privacy Information Officer.
Office Financial Policy
I understand that my dentist and staff will estimate insurance coverage as accurately as possible. I understand that I am responsible for the payment of my account and for providing correct insurance information.
Individual insurance policies vary with respect to personal coverage and fee schedule guidelines. It is the patient’s responsibility to understand the details of their personal insurance coverage.
Pre-authorizations for specific dental services will be sent to the insurance carrier when requested by the patient. Pre-authorizations are estimates only and are not a guarantee of payment, and all fees are subject to change.
I understand that if insurance is not applicable or does not cover the dental services rendered, full payment is due at the time of service.
I Am Responsible for My Balance if Any of the Following Occur:
- Treatment goes over my maximum benefits.
- Insurance benefits have been utilized elsewhere.
- I am not eligible for insurance when services are rendered.
- I prevent or delay the payment by not complying with requests for insurance forms or signatures.
- I do not complete my treatment, and it results in a payment by the insurance company.
- Lab costs are incurred due to missed appointments.
- Lab modifications.
- I received my insurance check and did not send it to your office.
- I have read and understand my obligations in acceptance of my dental insurance as payment.
I have read and understand my obligations regarding the acceptance of my dental insurance as payment.
Cancellations and Missed Appointments
Your appointment time is reserved specifically for you. To ensure appointment availability and to respect the time of all patients and providers, we have established the following policies.
Short Notice Cancellation
- Any appointment cancelled with less than 48 hours’ notice is considered a short notice cancellation.
- We understand that emergencies happen, and we will always consider circumstances when appropriate.
No Shows
- Any appointment where a patient does not attend or does not notify the office in advance is considered a no-show.
- All no-show appointments may be subject to a $75.00 fee
Three Strike System
No shows and short-notice cancellations each count as one strike.
Once a patient reaches three strikes, the following may apply
- Limitation to same-day appointment bookings only.
- No pre-booking of future appointments until consistency has been demonstrated.
- Appointment deposits may be required at the office’s discretion.
- Possible dismissal as a patient.
Late Arrival Policy
Arriving Up to 10 Minutes Late
If you arrive up to 10 minutes late, we will do our best to accommodate you. However, your appointment may need to be adjusted to help us remain on schedule.
Arriving 10–15 Minutes Late
If you arrive 10 to 15 minutes late, we may only be able to complete a limited portion of your appointment. If adequate treatment cannot be completed safely, your appointment may need to be rescheduled.
Arriving 15 Minutes or More Late
If you arrive 15 minutes or more late, your appointment will be cancelled and will need to be rescheduled.
Acknowledgement
I have read & understand the Appointment Cancellation Policy of the dental office and agree to be bound by its terms.
I also understand and agree that these terms may be amended by the dental office from time to time.
Conditions for Safe & Appropriate Dental Care
Our office is committed to providing dental treatment that meets professional standards while prioritizing the safety and well-being of our patients and team. The following conditions help ensure that dental care can be provided safely and appropriately.
Diagnostic Requirements
Current diagnostic information may be required before dental care can be provided to support an accurate diagnosis and appropriate treatment.
This may include:
- Recommended radiographs (X-rays)
- Dental examinations
- Other diagnostic records, when necessary
If a patient declines recommended diagnostic procedures, we may be unable to provide treatment.
Active Infections & Oral Conditions
For infection treatment purposes, treatment may be postponed if a patient presents with an active infection, including:
- Cold sores (Herpes Simplex Virus)
- Active tuberculosis (TB)
- Other respiratory or contagious illnesses
Dental procedures that create tiny droplets in the air may spread saliva, which can increase the risk of passing infections to both patients and our dental team.
Treatment will generally be rescheduled once the condition has resolved and is no longer considered contagious.
Medical Considerations & Clearance
- Certain medical conditions or medications may affect dental treatment.
- In some situations, medical clearance from a physician or specialist may be required before treatment can begin.
- If appropriate medical clearance is obtained, treatment may be delayed or modified in the interest of patient safety.
Clinical Judgment & Patient Safety
All treatment decisions are based on professional clinical judgment and patient safety.
Treatment may be delayed, modified, or declined if conditions are not suitable for safe and appropriate dental care.
Acknowledgement
All treatment decisions are based on clinical judgment and treatment safety. Treatment may be delayed, modified, or declined if conditions are not suitable for safe and appropriate care.
treatment, and that treatment may be delayed, modified, or declined if the necessary conditions for safe and appropriate dental care are not met.