PURPOSE OF CONSENT:
By signing this form, you consent to Aligner Experts use and disclosure of your protected health information (PHI) to carry out treatment, payment, and healthcare operations.
REVOCATION:
You will have the right to revoke this Consent at any time by giving us written notice of your revocation submitted to our Privacy Official listed in our NPP. Please understand that revocation of this Consent will not affect any action we took in reliance on this Consent before we received your revocation, and that we may decline to treat you, or to continue treating you.
I have had full opportunity to read and consider the contents of this Consent form and understand that, by signing I give my consent to your use and disclosure of my protected health information to carry out treatment, payment and healthcare operations.
EMAILING X-RAYS:
To provide the best treatment to our patients, it may be necessary for us to email x-rays to other specialists or dentists. This allows other offices to have better diagnostic tools available to them.