Personal Information & Consent Form
Your privacy matters. Learn about how we collect, use, and protect your personal information.
At London Square Dental, we take your privacy seriously. The personal information and consent form outlines how we collect, use, and safeguard your personal health information. We are committed to transparency and comply with all applicable Alberta privacy legislation.
What You Are Consenting To
By signing the consent form, you authorize the following:
- Collection and use of personal health information for treatment
- Sharing of information with insurance providers for claims processing
- Communication via phone, email, or text for appointment reminders
- Referrals to specialists when needed, including transfer of relevant records
- Storage of dental records in compliance with Alberta privacy regulations
- Use of photographs or X-rays for treatment planning purposes
Our Privacy Commitments
Confidential Records
All patient records are stored securely and access is limited to authorized dental team members involved in your care.
Alberta Privacy Laws
We comply fully with the Health Information Act (HIA) and the Personal Information Protection Act (PIPA) of Alberta.
Limited Disclosure
Your information is only shared with third parties when necessary for your care or billing, and only with your consent.
Right to Access
You have the right to access your personal health information, request corrections, and understand how your data is used.
Your Rights
You have the right to withdraw your consent at any time, request access to your personal information, or ask for corrections to your records. To exercise any of these rights, please contact our office at (403) 291-4945 or speak with our front desk team during your visit.
The consent form is completed at our office during your first visit. If you have questions about any section, our team will take the time to explain everything before you sign.
Looking for an Affordable Family Dentist in Calgary?
Join 4,800+ happy patients at London Square Dental Centre. Book a no obligation consultation today and receive a free professional whitening kit included with checkup and cleaning. Open 7 days a week with evening appointments available.
0% Financing Available