HIPAA – Health Insurance Portability and Accountability Act.

Patient Rights

This new law is careful to describe that you have the following rights related to your health information.


You have the right to request restrictions on certain uses and disclosures of your health information.

Confidential Communications

You have the right to request that we communicate with you in a certain way. You may request we only communicate your health information privately with no other family members present or through mailed communications that are sealed.

Inspect and Copy your Health Information

You have the right to read, review, and copy your health information, including your complete chart, x-rays and billing records.

Amend your Health Information

You have the right to ask us to update or modify your records if you believe your health information records are incorrect or incomplete. Your request may be denied if the health information record in question was not created by our office.

Documentation of Health Information

You have the right to ask for a description of how and where your health information was used by our office at any time. You have the right to express complaints to us or to the Security of Health and Human Services if you believe your privacy rights have been compromised.

Smile 4 Life Dental agrees to treat you to the best of their abilities and acknowledges your choice as their guest, and supports your rights as a client/patient.


Download the patient HIPAA consent form:  HIPAA Information Form (4203 downloads)