HIPAA Privacy Consent Form

Notice of Privacy Practices for Protected Health Information

The privacy practices notice below describes how medical information about you may be used and disclosed and how you can get access to this information.

With your consent, Tendler Orthodontics is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. Protected health information is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examination and applying for future care or treatment. It also includes billing documents for those services.

Please use the button to review the Notice of Privacy Practices for Protected Health Information document for your orthodontic treatment. If you have any questions, please call our office: Tendler Orthodontics Phone Number 561-826-7955.

Notice of Privacy Practices

Technical Note

These forms are in PDF format. If you do not have Adobe Reader installed on your computer, you may download Acrobat Reader for free and use it to access these forms.