Forest Hill Dental provides our patients with a downloadable print version or our simple easy to fill out confidential online version. Please select the form in which you would like to submit.
Privacy of your personal information is an important part of our office just as providing you with quality dental care. We understand the importance of protecting your personal information and we are committed to collecting, using and disclosing your personal information responsibly. We also try to be as open and transparent as possible about the way we handle your personal information. It is VERY important to us to provide this service to all of our patients.
In this dental office, the dental centre manager acts as the privacy information officer. All staff members who come in contact with your personal information are aware of the sensitive nature of the information that you have disclosed to us. They are all trained in the appropriate uses and protection of your information. Here is an outlined policy that our office follows to ensure you that:
Please do not hesitate to discuss our policies with me or any member of our office staff and be assured that every staff person in our office is committed to ensuring that you receive the best quality dental care.
Our office understands the importance of protecting your personal information. To help you understand how we are doing that, we have outlined here how our office is using and disclosing your information. This office will collect, use and disclose information about you for the following purposes:
By signing the consent section of this patient consent form, you agreed that you have given your informed consent to the collection, use and/or disclosure of your personal information for the purposes that are listed. If a new purpose arises for the use and/or disclosure of your personal information, we will seek your approval in advance.
Your information may be accessed by regulatory authorities under the terms of the Regulated Health Professions Act (RHPA) for the purposes of the Royal College of Dental Surgeons of Ontario fulfilling its mandate under the RHPA, and for the defence of a legal issue.
Our office will not under any conditions supply your insurer with your confidential medical history. In the event this kind of request is made, we will forward the information directly to you for review, and for your specific consent. When unusual requests are received, we will contact you for your permission to release the necessary information. We may also advise you if such a release is inappropriate. You may withdraw your consent for use or disclosure of your personal information, and we will explain the ramifications of that decision, and the process.
I have reviewed the above information that explains how your office will use my personal information and the steps your office is taking to protect all of my personal and confidential information. I agree that Forest Hill Dental Care can collect, use and disclose personal information as set above in the information about the office's privacy policies.
This is to certify that I, the undersigned, have read the forgoing and consent to the performing of the dental procedures agreed to be necessary or advisable. I will assume responsibility for fees associated with those procedures.