I the undersigned acknowledge that the information stated is true and
correct and accurately represents the medical history of the person
receiving treatment. If any personal or medical history changes I
will notify Peel Orthodontics immediately to update my records.
In the event that the account is not paid within our normal trading
terms, I/we agree to pay all late charges and any debt collection costs
associated with the collection of these overdue fees.
Our Practice respects your rights 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
is available from our website at www.morethanasmile.com.au or please ask
reception for a copy.
- If consent to treatment is withdrawn before starting the proposed treatment, any expenses incurred for laboratory fees, administration services, appliance fees or any other expenses will still be payable.
- The information collected will be used for the purpose of providing treatment, or to process accounts, payments and writing to you about our services and any issues affecting your treatment.
- We may disclose your health information to other health care professionals, or require it from them if, 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. I understand that once released, Peel Orthodontics has no responsibility for any release by the individual receiving this information.
- We may also use part of your health information for research purposes, in study groups or at seminars that may provide benefits to other patients. Your personal identity will not be disclosed without your consent to do so.
Use of clinical photographs and records
Here at Peel Orthodontics, we are proud of the smiles we create for
you. We would love to show off your smile, not just for their gorgeous
looks, but also for education and scientific purposes. The mediums in
which this could happen include, scientific journals and lectures,
our web page and our in-practice presentations. We are committed to
providing you with excellence in orthodontics and consider continuing
education and keeping updated in the latest orthodontic technology an
integral part of this. Please give us permission to use your clinical
photographs, as this will allow us to contribute to the improvement of
orthodontics worldwide. I consent to the photographic records being
available for use by Peel Orthodontics for the reasons listed above.