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DR. LEVITIN Dentistry Professional Corporation



Privacy of your professional information is an important part of our office providing you with quality dental care. We understand the importance of protecting your personal information. We are committed to collecting, using and disclosing your personal information responsibly. We also try to be as open and transparent as possible about the way we handle your personal information. It is important to us to provide this service to our patient.

In this office, Dr.A. Levitin acts as the privacy information officer.
All staff members who come in con t with personal information are aware of the sensitive nature of the information that you have disclosed to us. They are all trained in the appropriate used and protection of your information attached to this consent form, we have outlined what our office is doing to ensure that:

Do not hesitate to discuss our policy with me or any members of our office staff. please be assured that every staff person in our office is committed to ensuring that you receive the best quality dental care.

How Our Office Collects, Uses and Discloses Patient Personal Information?

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

By singing the consent section, of this Patient Consent Form, you have agreed that you have given your informed consent to collection, use and /or disclosure of your personal information for the purpose that are listed. If a. new purpose arises for the use and/or disclosure of your personal information, we will seek your approval in advance.

Your information be accessed by regulatory authorities under the term of the Regulated Health Professions Act (RHPA) for the purpose of the Royal Collage of Dental Surgeons of Ontario fulfilling its medicate, under the RHPA, band for the defense of a legal issue.

You may withdraw your consent for use and disclosure of your personal information, and we will explain the ramifications of that decision, and the process.

Patient Consent

I have reviewed the above information that explains how your office will use my personal information, and the steps your office is taking to protect my information. - I know that your office has a privacy Code, and I can ask to see the code at any time.

I agree that Dr. A. Levitin Dentistry Professional Corporation, and its successors, can collect use and disclose personal infromation about as set out above in the information about the office's privacy policies.