HIPAA Form
We take the privacy and security of your personal health information very seriously at Castle Pines Orthodontics. That's why we have implemented strict measures to ensure your protected health information (PHI) remains confidential and secure.
To comply with the Health Insurance Portability and Accountability Act (HIPAA), we require all patients to sign our HIPAA authorization form before we can proceed with any orthodontic treatment. By signing this form, you authorize us to use and disclose your PHI for purposes related to your treatment, payment, and healthcare operations.
Your PHI may include your name, address, phone number, social security number, medical history, and other sensitive information. We understand the importance of keeping your PHI confidential and we will only use and disclose it in accordance with the HIPAA Privacy Rule.
We encourage you to review our Notice of Privacy Practices for a more detailed explanation of our policies and procedures. If you have any questions or concerns about our HIPAA authorization form or our privacy practices, please don't hesitate to contact us.
To download and complete our HIPAA authorization form, please click the link below. Thank you for choosing Castle Pines Orthodontics for your orthodontic needs. We look forward to providing you with exceptional care.
Download:
HIPAA Form
Contact Us
Castle Pines Orthodontics is a family-operated business that has been providing the highest quality orthodontic care to the Castle Pines community since 2002. We are committed to patient-centered care and community involvement, supporting local schools and serving those in need. Contact us today to schedule a complimentary consultation and begin your journey towards a healthy, beautiful smile.