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    • Home
    • New Patients
      • Patient Registration Form
      • Privacy Policy
    • Before Surgery
      • Consent Form
      • Before Sedation
      • Questionnaire
      • GP History/Physical Form
      • GP Request for Blood work
      • Covid-19 Acknowledgement
      • COVID-19 Test
    • After Surgery
      • Post-Wisdom Teeth Removal
      • Post-Dental Implants
      • Post-Teeth Extraction
      • Post Operative Guide
    • Online Referral
    • Contact Us
      • Guelph Oral Surgery
      • Waterloo Oral Surgery
      • Doctor Bios
    • Procedures
    • Financial Policy

  • Home
  • New Patients
    • Patient Registration Form
    • Privacy Policy
  • Before Surgery
    • Consent Form
    • Before Sedation
    • Questionnaire
    • GP History/Physical Form
    • GP Request for Blood work
    • Covid-19 Acknowledgement
    • COVID-19 Test
  • After Surgery
    • Post-Wisdom Teeth Removal
    • Post-Dental Implants
    • Post-Teeth Extraction
    • Post Operative Guide
  • Online Referral
  • Contact Us
    • Guelph Oral Surgery
    • Waterloo Oral Surgery
    • Doctor Bios
  • Procedures
  • Financial Policy

Privacy Policy

Privacy of your personal information is an essential part of our office providing you with quality care. We are committed to collecting, using, and disclosing your personal information responsibly. We also try to be as open and transparent as possible about the way we handle your personal information.


In our office, the Privacy Information Officer is: Dr. A. Mobini.
All staff members who come in contact with your personal information are aware of the sensitive nature of the information that you have disclosed to us. They are all trained in the appropriate uses and protection of your information.

  • Only the necessary information is collected about you.
  • We only share your information with your consent.
  • Storage, retention, and destruction of your personal information complies with existing legislation and privacy protocols.
  • Our privacy protocols comply with privacy legislation, standards of our regulatory body and the law.


How Our Office Collects, Uses & Discloses Patients' Personal Information

Our office understands the importance of protecting your personal information.This office will collect, use and disclose information about you for the following purposes:

  • To deliver safe and efficient care and to ensure continuous high quality health care.
  • To assess your health needs and to advise you of treatment options.
  • To enable use to contact you to establish and maintain communication.
  • To communicate with other treating health-care providers, including Specialists and referring Doctors.
  • To allow follow-up for treatment, care and billing, and to book and confirm appointments.
  • For teaching and demonstrating purposes on an anonymous basis.
  • To complete and submit claims for third party adjudication and payment.
  • To comply with agreements/undertakings entered into voluntarily by the member with governing bodies, including the delivery and/or review of patients' charts and records in a timely fashion for regulatory and monitoring purposes.
  • To permit potential purchasers, practice brokers or advisors to evaluate the practice or conduct an audit in preparation for a practice sale.
  • To deliver your charts and records to the office's insurance carrier to enable the insurance company to assess liability and quantify damages, if any.
  • To prepare materials for the Health Professions Appeal and Review Board(HPARB)
  • To invoice for goods and services, to process credit card payments, and to collect unpaid accounts.
  • To assist this office to comply with all regulatory requirements under the law.


By signing the Patient Consent Form, you have agreed that you have given your informed consent to the collection, use and/or disclosure of your personal information for the purposes that are listed. If a new purpose arises for the use and/or disclosure of your personal information, we will seek your approval in advance. Your information may be accessed by regulatory authorities under the terms of the Regulated Health Professions Act(RHPA) and for the defense of a legal issue.


Our office will not under any conditions supply your Insurer with your confidential medical history. In the event this kind of a request is made, we will forward the information directly to you for review, and for your specific consent. When unusual requests are received, we will contact you for permission to release such information. We may also advise you if such a release is inappropriate.
You may withdraw your consent for use or disclosure of your personal information, and we will explain to you the ramification of that decision, and the process.

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