Information for our Patients
At Peace Country Dental Clinic, all professional services are performed by licensed members of the BC College of Dental Surgeons (“Dental Professionals”), and all institutional services are performed independently by Peace Country Health Services, under the clinical supervision and control of Dental Professionals in a cost-sharing arrangement. Peace Country Dental Clinic and Peace Country Health Services are each independent entities providing independent services but for ease of administration may render joint invoices for their respective services. One or more of our Dental Professionals may have a financial interest in Peace Country Health Services.
Privacy Act and Consent to Treatment
By signing this form in our office, you acknowledge and agree that (i) you have read and understood the above information prior to any professional services being provided to you by any Dental Professional; (ii) you have been provided and have read a copy of our Privacy Code; (iii) you agree to the collection, use and disclosure of your Personal Information in accordance with our Privacy Code; and (iv) your previously signed consent and acknowledgment documents are extended in favour of Peace Country Dental Clinic and Peace Country Health Services.
You can withdraw your consent at any time on the understanding that withdrawing your consent to certain information handling practices may impair the ability of Peace Country Dental Clinic to provide the services you are requesting.
Thank you and please do not hesitate to let us know if you have any questions regarding this form or your Personal Information.