Patient Consent Form: For Collection, Use And Disclosure Of Personal Information

Maintaining privacy of your personal information is important to us for rendering quality dental service to you. This Privacy Policy regulates the manner in which we collect, use, maintain and disclose information collected from users (each, a "User"/”user”) of this website.

How We Collect Patients' Personal Information

Users’ personal identification information may be collected by us in a variety of ways, including, but not limited to, when they visit our site (www.smileorchid.in), fill out a form, and in connection with other activities, services, features or resources we make available on our site. Users may be asked for, as appropriate, name, email address, phone number. Users may, however, visit our site anonymously. We will collect personal identification information from users only if they voluntarily submit such information to us. Users can always refuse to provide personal identification information, except that, it may prevent them from engaging in certain site related activities. We may collect non-personal identification information about users whenever they interact with our site. Non-personal identification information may include the browser name, the type of computer and technical information about users’ means of connection to our site, such as the operating system and the internet service providers utilized and other such similar information. We recognize the importance of protecting your collected personal information. We are bound to collecting, using and disclosing your personal information responsibly. All our dental office staff members who may come in contact with your personal information are aware of the sensitive nature of the information you have disclosed to us. They are all instructed and trained for appropriate use and protection of your information. We strive to be as transparent as possible about the way we handle your personal information. It is important to us to provide this service to our patients. Attached to this consent form, we have outlined how we ensure that:

  • Only necessary information is collected about you;

  • We only share your information with your consent;

  • Storage, retention and destruction of your personal information complies with existing legislation and privacy protection protocols.

Web browser cookies

Our site may use "cookies" to enhance user experience. User's web browser places cookies on their hard drive for record-keeping purposes and sometimes to track information about them. Users may choose to set their web browser to refuse cookies, or to alert you when cookies are being sent. If done so, note that some parts of the site may not function properly.

How we use and disclose patients' personal information

We understand the importance of protecting your personal information. To help you understand how we are doing that, we have outlined here how our office/site is using and disclosing your information. We will collect, use and disclose information about you for the following purposes:

  • To deliver safe and efficient patient care

  • To provide appropriate quality health care

  • To advise you of treatment options available

  • To identify and to ensure continuous high quality service

  • To assess your health needs

  • To enable us to contact you

  • To establish and maintain communication with you

  • To offer and provide treatment, care and services in relation to the oral and maxillo-facial complex and dental care generally

  • To communicate with other treating health-care providers, including specialists and general dentists who are the referring dentists and/or peripheral dentists

  • To allow us to maintain communication and contact with you to distribute health-care information and to book and confirm appointments.

  • To allow us to efficiently follow-up for treatment, care and billing.

  • For teaching and demonstrating purposes on an anonymous basis

  • To complete and submit dental claims for third party adjudication and payment

  • To permit potential purchasers, practice brokers or advisors to evaluate the dental practice

  • To allow potential purchasers, practice brokers or advisors to conduct an audit in preparation for a practice sale

  • To invoice for goods and services

  • To process credit card payments

  • To collect unpaid accounts

  • To assist this office to comply with all regulatory requirements

  • To comply generally with the law

  • To improve our customer service

How we protect your information

We adopt appropriate data collection, storage and processing practices and security measures to protect against unauthorized access, alteration, disclosure or destruction of your personal information, username, password, transaction information and data stored on our site.

Sharing your personal information

We do not sell, trade or rent users’ personal identification information to others. We may share generic aggregated demographic information not linked to any personal identification information regarding visitors and users with our business partners, trusted affiliates and advertisers for the purposes outlined above. In compliance with children's online privacy protection act, protecting the privacy of the very young is especially important to us. For that reason, we never collect or maintain information at our site from those we actually know are under 13 and no part of our website is structured to attract anyone under 13.

Changes to this privacy policy

We have the discretion to update this privacy policy at any time. We encourage users to frequently check this page for any updates or changes to stay informed about how we are helping to protect the personal information we collect. You acknowledge and agree that it is your responsibility to review this privacy policy periodically and become aware of modifications. Your acceptance of these terms, by using this site, you signify your acceptance of this policy. If you do not agree to this policy, please do not use our site. Your continued use of the site will be deemed as your acceptance of those changes. Contact us if you have any queries about this Privacy Policy, the practices of this site or your dealings with this site. We will not, under any condition, supply your insurer with your confidential medical/dental history. In the event of, a 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 permission to release such 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.

By signing the consent section of this Patient Consent Form, you have 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.

How we protect your information

We adopt appropriate data collection, storage and processing practices and security measures to protect against unauthorized access, alteration, disclosure or destruction of your personal information, username, password, transaction information and data stored on our site.

Patient Consent

I have reviewed the above information that explains how your dental office/site will use my personal information and the steps your dental office/site is taking to protect my information. I agree that smileorchid.in can collect, use and disclose my personal information as set out above in the information about its privacy policies.

Interested? Complete the form below and we will contact you today! Or feel free to call us at +914448588269; +919043158269; +919551027641.