Read This Statement Carefully:

Due to Privacy Legislation, we require your consent to collect personal information. This practice collects your information to identify your medical record and provide an accurate, quality health service. This means that we will use the information you provide in the following ways:

Administrative purposes in running a specialist dental practice include pre-operative and post-operative calls using phone numbers and names you provide us and hospital interaction for booking surgical services.

Billing purposes, including compliance with Medicare and Health Insurance Commission requirements.

Disclosure to others involved in your medical care, including treating doctors, specialists, hospital booking staff outside this practice. This may occur through referral to other doctors, surgery at hospitals, medical tests, and the reports or results returned to us following the referrals.

Important:

I have read the information above and understand the reasons why my information must be collected.

I am also aware that this practice has a privacy policy on handling patient information.

I understand that I am not obliged to provide any information requested. Still, failure to do so might compromise the quality of health and treatment provided to me.

I am aware of my right to access the information collected about me, except in circumstances where access might legitimately be withheld. I understand I will have these circumstances explained.

I understand that my further consent will be obtained if my information is to be used for any other purpose other than that set out above.

I consent to the handling of my information by this practice for the purpose set out above, subject to any limitations on access or disclosure that I notify this practice of.

I understand that my personal information may go offshore if I select email as a preferred contact mode.

Note: Due to the privacy laws, results cannot be given to a third party unless written authorization is obtained or under exceptional circumstances.