Patient Rights & Responsibilities
Understanding your rights and responsibilities as a patient in our dental practice.
Your Rights as a Patient
Right to Quality Care
You have the right to receive competent, compassionate dental care in a safe and clean environment.
Right to Informed Consent
You have the right to be informed about proposed treatments, alternatives, risks, benefits, and costs before consenting to care.
Right to Privacy
You have the right to confidential treatment of your medical and personal information in accordance with HIPAA.
Right to Access Records
You have the right to review and obtain copies of your dental records within a reasonable timeframe.
Right to Refuse Treatment
You have the right to refuse any treatment, understanding the potential consequences of that decision.
Right to Second Opinion
You have the right to seek a second opinion from another qualified dental professional.
Right to Emergency Care
You have the right to receive information about emergency dental care and how to access it.
Right to File Complaints
You have the right to voice grievances and have them reviewed and resolved without affecting your care.
Your Responsibilities as a Patient
Provide Accurate Information
Provide complete and accurate medical and dental history, including medications, allergies, and health conditions.
Follow Treatment Plans
Follow agreed-upon treatment plans and post-treatment instructions for optimal outcomes.
Keep Appointments
Arrive on time for appointments and provide at least 24 hours' notice for cancellations.
Ask Questions
Ask questions if you don't understand your diagnosis, treatment options, or instructions.
Respect Staff
Treat our staff and other patients with respect and courtesy at all times.
Financial Responsibility
Pay for services rendered according to our financial policies and insurance agreements.
Report Changes
Inform us of any changes in your health status, medications, or contact information.
Maintain Oral Health
Practice good oral hygiene between visits and attend regular check-ups as recommended.
Notice of Privacy Practices
HIPAA requires us to provide you with this notice about how we protect your health information.
How We May Use Your Information: For treatment, payment, and healthcare operations without your authorization.
Your Rights: Access your records, request amendments, receive confidential communications, and file complaints.
Our Duties: Protect your privacy, provide this notice, and abide by its terms.
How to File a Complaint
If you believe your privacy rights have been violated or have concerns about your care, you may file a complaint:
With Our Practice:
Contact our Privacy Officer at 606-330-0330 or in writing at:
908 West 5th Street, Suite 114, London, KY 40741
With the U.S. Department of Health and Human Services:
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
1-800-368-1019 | www.hhs.gov/ocr/privacy/hipaa/complaints/
You will not be retaliated against for filing a complaint in good faith.
Effective Date: July 15, 2026
Last Updated: 9/28/2026
This document is provided in accordance with HIPAA regulations and Kentucky state law. Available in alternative formats upon request.