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Learn about the Dentist Office Calgary Has Trusted Since 2003

 

Northland Village Dental Centre in Calgary takes your privacy concerns seriously, and it is important to us that our patients know our policies. On this page you can read our notice of privacy practices, and consent to the terms laid out therein. You can also contact us directly if you have questions.

 

Notice of Privacy Practices

We are committed to protecting the privacy of our patients’ personal information and to utilizing all personal information in a responsible and professional manner. This document summarizes some of the personal information that we collect, use and disclose. In addition to the circumstances described in this form, we also collect, use and disclose personal information when permitted or required by law.

We collect information from our patients such as names, home addresses, work addresses, home telephone numbers, work telephone numbers, and email addresses (collectively referred to as "Contact Information").

Contact information is collected and used for the following purposes:

To open and update patient files.

To invoice patient for dental services, to process credit card payments, or to collect unpaid accounts.

To process claims for payment or reimbursement from third-party health benefit providers and insurance companies.

To send reminders to patients concerning the need for further dental examinations or treatments.

To send patients informational materials about our dental practice.

Contact information is disclosed to third-party health benefit providers and insurance companies where the patient has submitted a claim for reimbursement or payment for all or part of the cost of dental treatment or has asked us to submit a claim on the patient’s behalf.

Financial information may be collected in order to make arrangements for the payment of dental services.

We collect information from our patients about their health history, their family’s health history, physical condition and dental treatments (collectively referred to as "Medical Information"). Patient’s medical information is collected and used for the purpose of diagnosing dental conditions and providing dental treatment.

Patient’s medical information is disclosed:

To third-party health benefit providers and insurance companies where the patient has submitted a claim for reimbursement or payment for all or part of the cost of dental treatment or has asked us to submit a claim on the patient’s behalf.

To other dentists and dental specialists, where we are seeking a second opinion and the patient has consented to us obtaining the second opinion.

To other dentist and dental specialists if the patient, with his or her consent, has been referred by us to the other dentist or dental specialists for treatment.

To other dentists and dental specialists where those dentists have asked us, with the consent of the patient, to provide a second opinion.

To other health care professionals such as physicians if the patient, with their consent, has been referred by us to the other healthcare professionals for either a second opinion or treatment.

If we are ever considering selling all or part of our dental practice, qualified potential purchasers may be granted access as part of the due diligence process to patient information in order to verify information important to the potential sale. If this occurs, we will take steps to ensure that the prospective buyer safeguards all personal information.

Dentists are regulated by the Alberta Dental Association and College which may inspect our records and interview our staff as part of its regulatory activities in the public interest.

I consent to the collection, use and disclosure of my personal information as set out above.

Patient Name:

Signature (Please write name):

Date

Request an Appointment

Request an Appointment

Dental issues can get worse over time if neglected.

Contact Us

Contact Us

If you have any queries, please don’t hesitate to reach out to us.

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