118 Tilley Dr., #101, South Burlington, VT 05403
802-863-3950Privacy Policy
Green Mountain Dental
Website Privacy Policy
Thank you for visiting our website. Green Mountain Dental is committed to respecting your online privacy. The following privacy policy sets forth how we use personal information collected at this site. Please read the entire privacy policy before using the site or submitting any of your personal information. When you use the site, you are accepting the practices described in this policy. The privacy practices may be changed in the future. Any changes will be posted and changes will only apply to activities and information in the future, not retroactively. Please review the privacy policy every time you visit our site to understand how personal information you provide will be used.
Collected Information
We collect personal information such as names, phone numbers, email addresses, etc., only when voluntarily submitted by our visitors. The information you provide is only used to fulfill your particular request unless you give us permission to use it in another manner.
Terms & Conditions
By providing your phone number by phone or online, you consent to receive SMS text messages from Green Mountain Dental. Message and data rates may apply. You may reply STOP to opt out of messages.
Shared Information
We may share information with government agencies or any other companies assisting us in fraud prevention or investigation. We may do so when permitted or required by law or when investigating fraud that has already taken place. We also may use other businesses to perform certain services for us, such as maintaining our site and our email services and processing inquiries. We may provide personal information to those businesses when that information is necessary for them to complete a requested transaction or otherwise perform their duties. We will not sell or share your personal information with any unaffiliated third parties for marketing purposes.
Collective Data
Occasionally, we may collect statistical and non-personal information about the use of the site. This information may include how many visitors visit a specific page on the site, how long they stay there, and which hyperlinks they visit. We collect this information to determine which areas of the site are most popular and where to enhance the site for our visitors. This collective data may be used to describe the use of our site to third parties or in response to a government request. However, this data will not personally identify you or any other of our website visitors.
Links to Other Sites
While visiting our site, it is possible that you could be directed (via hyperlink or other means) to other sites that are outside of our control. These other websites may send their own cookies to visitors, collect data, or solicit your personal information. It is important that you read the privacy policies of these other sites before using them. We are not responsible for the privacy practices of other websites and cannot guarantee the security of any personal information that is collected on those other sites.
Contact Us
We reserve the right to make changes to our privacy policy. Any changes to this privacy policy will be posted here. If you have any questions or concerns about our Privacy Policy, please contact us at:
Green Mountain Dental
118 Tilley Dr., #101
South Burlington, VT 05403
802-863-3950
I understand that I have certain rights to privacy regarding my protected health information. These rights are given to me under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). I understand that by signing this consent I authorize you to use and disclose my protected health information to carry out:
- Treatment (including direct or indirect treatment by other healthcare providers involved in my treatment)
- Obtaining payment from third party payers (e.g. my insurance company)
- The day-to-day healthcare operations of your practice.
I have also been informed of and given the right to review and secure a copy of your Notice of Privacy Practices, which contains a more complete description of the uses and disclosures of my protected health information and my rights under HIPAA. I understand that you reserve the right to change the terms of this notice from time to time and that I may contact you at any time to obtain the most current copy of this notice.
I understand that I have the right to request restrictions on how my protected health information is used and disclosed to carry out treatment, payment, and health care operations, but that you are not required to agree to these requested restrictions. However, if you do agree, you are then bound to comply with this restriction.
I understand that I may revoke this consent, in writing, at any time. However, any use or disclosure that occurred prior to the date I revoke this consent is not affected.
CONSENT FOR TREATMENT:
I hereby grant authority to the dentist(s) in charge of the care of the patient whose name appears on this Health History form, to administer such anesthetics, analgesics, sedatives, nitrous oxide sedation, and intravenous sedation; and to perform such operations as may be deemed necessary or advisable in the diagnosis and treatment of this patient. I have been informed of all possible complications of the procedures, anesthetics and/or drugs.
YOUR RIGHTS:
You have the right to have access and/or copies of your PHI records at any time. You have the right to request additional restrictions on your PHI, and we will do so unless legally bound otherwise. You have the right to refuse to sign the consent form, or to rescind your consent.
For more information or to file a complaint contact our Privacy Officer, Leisel Bailey at 802-863-3950.
ADDITIONAL PRIVACY INFORMATION
Green Mountain Dental maintains strict privacy policies to protect the personal information of our users obtained for text message communications. This information is never sold, rented, released, or traded to others without prior consent or legal obligation. Any sharing of information with third parties is solely for the purpose of fulfilling the organization’s obligations to the user. Personally identifiable information will never be shared with third parties for marketing purposes.
TEXT MESSAGE OPT-OUTS
Text Message Opt-Out: If you are receiving text messages from us and wish to stop receiving them, simply respond with either “STOP” or “UNSUBSCRIBE” to the number from which you received the message.