Patient Rights
Access to Care
- Receive quality orthodontic care regardless of race, gender, religion, or national origin
- Be treated with respect and dignity by all practice staff
- Receive complete information about your treatment options, risks, and benefits
- Access your treatment records and obtain copies upon request
Communication and Information
- Receive clear explanations about your orthodontic condition and treatment plan
- Ask questions and receive timely responses from your orthodontist
- Be informed about treatment costs and payment options
- Receive advance notice of appointment changes
Privacy and Confidentiality
- Have your medical information kept confidential per HIPAA regulations
- Private consultation spaces for discussing treatment
- Choose who may access your treatment information
Patient Responsibilities
Treatment Compliance
- Follow orthodontic treatment instructions carefully
- Wear orthodontic appliances as directed
- Maintain proper oral hygiene throughout treatment
- Attend all scheduled appointments
Communication
- Provide accurate medical and dental history
- Inform the office of changes in medical status or medications
- Give 24-hour notice for appointment cancellations
- Report any problems with appliances promptly
Financial Obligations
- Understanding your insurance coverage and benefits
- Making timely payments as agreed upon
- Discussing any financial concerns promptly
Acknowledgment
I have read and understand my rights and responsibilities as outlined above.
Patient Name: _________________
Date: _________________
Signature: _________________
Parent/Guardian (if applicable): _________________