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Our practice respects your right to privacy. We realise that it is important that you understand the purpose for
which we collect details about your health, as well as how this information is used at our practice and to
whom this information might be disclosed.

The policy of our practice is to follow these procedures:

1. The information collected will be used for the purpose of providing treatment to you. Personal
information such as your name, address and health insurance details will be used for the purpose of
addressing accounts to you, as well as processing payments and writing to you about our services and
any issues affecting your treatment.

2. We may disclose your health information to other health care professionals, including specialists we
may refer you to, or require it from them, in our judgement, that is necessary in the context of your
treatment. In that event, disclosure of your personal details will be minimised wherever possible.

3. We may also use parts of your health information for research purposes, in study groups or at
seminars as this may provide benefit to other patients. Should that happen, your personal identity will
not be disclosed without your consent to do so.

4. Your medical history, treatment records, x-rays and any other material relevant to your treatment will
be kept here. You may inspect or request copies of our records of your treatment at any time, or seek
an explanation from the dentist. Statutory fees will apply in relation to the types of access you seek.
If you request an explanation of our records or a written summary, our usual fees apply to these

5. If any of the information we have about you is inaccurate, you may ask us to alter our records

You can otherwise rest assured that your health information will be treated with the utmost confidentiality.
Disclosure will not be made to any person not involved in either your treatment or the administration of this
practice, without your prior written consent. If you have any queries or concerns about our handling of your
health information, please do not hesitate to raise these concerns with our practice.

Otherwise, please sign this form as confirmation that you have read and understood our privacy policy, and
consent to the use of your health information in this way.

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Customised Payment Plans

At Adelaide dental by design we can customise various payment options to suit individual circumstances following development of your treatment plan. Feel free to discuss this at your appointment.

A flexible funding plan specifically designed for the payment of dental plans may be available through: