Patient Information

• I have answered all questions to the best of my knowledge. Should further information be required, you have my permission to contact my medical practitioner, who may release such information to you.
• I consent to a dentist or designated team member to take x-rays, study models, photographs and other diagnostic aides as deemed appropriate by a dentist to make a thorough dental diagnosis.
• I agree to be responsible for payment of all services rendered on my behalf or my dependents. I understand that payment is due at the time of service unless other arrangements have been made. I also understand that if for any reason recovery of funds is required, and costs involved will be at my expense. I understand that if I cancel an appointment within 12 hours, I may be liable for payment of a cancellation fee.
• A deposit will be required for any appointments longer than an hour. The deposit goes towards the cost of the treatment

Please read this Privacy Collection Statement to see how we use your personal information.

We collect your personal information to provide you with products and services you have requested, improve our products and services, keep you informed of your upcoming appointments and notify you about our latest promotions and other offers relevant to you. We collect this information mainly through our communications with you, but we may do so also from other sources in the course of providing our services to you. You are not obliged to provide us with your personal information; however, this may impact our ability to provide you with our products and services. We generally do not disclose information about you to any person and will only share your personal information where necessary to provide you with products and services, as required by law, or with your permission. Our Privacy Policy sets out how you can access and change your personal information or make a privacy complaint.