Orthodontics Consultation

Orthodontics Consultation

Our greatest goal is to give you the healthy, straight, and beautiful smile you’ve always wanted. We understand that choosing to receive orthodontic care is a big decision, and we respect your reasons for wanting to improve the way you look and feel.Our practice will work with you every step of the way to make sure your orthodontic care is as rewarding as possible. We utilize the latest technology, and offer a variety of safe and gentle treatment options to give you the customized, individual care you deserve.
Girl Smiling at Dentist

PATIENT ACKNOWLEDGMENT OF NOTICE OF PRIVACY PRACTICES

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ACKNOWLEDGMENT OF RECEIPT

I acknowledge that I have been provided with a copy of the Notice of Privacy Practices (NPP) for AB Orthodontics, Inc., effective January 1, 2026.

I understand that this Notice describes how my protected health information (PHI) may be used and disclosed, how I may access my information, and my rights regarding the privacy of my health information, in accordance with the Health Insurance Portability and Accountability Act (HIPAA), as amended, and applicable federal and state law.

I understand that the Notice includes specific information regarding:

  • My privacy rights under HIPAA
  • How my dental and medical information may be used for treatment, payment, and health care operations
  • Special privacy protections for certain sensitive information, including substance use disorder records (42 CFR Part 2) and reproductive health information
  • How to file a complaint if I believe my privacy rights have been violated

I understand that AB Orthodontics, Inc. reserves the right to change its Notice of Privacy Practices and that a current copy will be available in the office, on the practice website (if applicable), and upon request.

PATIENT INFORMATION

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