Patient Privacy & Consent Form

Home Patient Privacy & Consent

Commitment to Patient Privacy

Burnside Dental Centre collects personal information necessary from you or another person acting on your behalf for the provision of professional oral health care services provided to you.

We’re committed to respecting your personal information. The disclosure of that information shall be restricted only to your oral health provider, other health care professionals and dental insurance providers.

Burnside Dental is also committed to protecting and managing your personal information from loss, theft and unauthorized access. Your information will be destroyed in a secure manner when the information is no longer necessary.

For your convenience, we are also able to connect with you through your very own patient portal. Here we are able to send only appointment confirmations, notifications, account information and updates via email and texting. If you would like to receive these notifications please fill out the information below.

Patient Privacy & Consent Form

Download a hard copy of the form given below: