Confidential Patient Information
I understand the above information is necessary to provide me with dental care in a safe and efficient manner. I have answered all questions to the best of my knowledge. Should further information be needed, you have my permission to ask the respective health care provider who may release such information to you. I will notify the dentist of any change in my health or medication.
Our goal is to provide patients with highest dental care and transparency. Before proceeding with a treatment all fees and financial arrangements will be discussed with you and your questions will be answered. We take the time to ensure that you understand exactly what is being done, the costs, benefits and the risks.
You will be asked to pay the fee at the time of service. You are responsible for the payment of all the fees for dental care rendered at Rosetta Dental. For your convenience if you would like we can contact your dental benefit provider so that you know what is covered. Since there is a possibility that the information given over the phone can be inaccurate, we cannot be accountable for what your benefits cover. We will submit the claim on your behalf and help you with any request your benefit provider might have.
Lateness/ No Show / Cancellation Policy: A scheduled appointment means that the Dentist and the rest of the team have reserved a time specifically for you and no other patients are seen at that time. If you know you cannot make your appointment we require 48 hours notice so that we can give your scheduled time to another patient. Patients who do not follow this policy may be charged a fee and/or may no longer remain patients of this practice.
Privacy of your personal health information is an important part of our office, providing you with quality dental care. We understand the importance of protecting your personal health information. We are committed to collecting, using and disclosing your personal health information. We also try to be as open and transparent as possible about the way we handle your personal health information. It is important to us to provide this service to our patients. All staff members who come in contact with your personal health information are aware of the sensitive nature of the information that you have disclosed to us. They are all trained in the appropriate uses and protection of your information.