We understand that your time is valuable, and we always try to accommodate your schedule for appointments. This makes our time very valuable as well. We also make every effort to remind you of your scheduled appointment time by using the communication means you have given us. In order to avoid broken appointments and late patient arrivals, the following policy has been adopted:

-All cancellations or rescheduled appointments must be arranged 48 hours prior to appointment date.

-If your appointment is on Monday please remember we are closed on Fridays and need to hear from you by Thursday at 3:00pm.

-Patients arriving more than 10 minutes late may be rescheduled.

-Patients who do not give adequate notice to reschedule or do not show up will be charged $75.00

I consent to treatment as necessary or desirable to my care, including but not restricted to whatever drugs, medicine, performance of operations and conduct of laboratory, x-ray, or other studies that may be used by the attending doctor, or his assistant or qualified designate.
I consent to the office submitting my claim to my insurance company and to the assignment of benefits. I understand the dental office will allow 60 days for my claim to be paid, after which, interest will be charged to my account.
I also acknowledge full responsibility for the payment of such services and agree to pay for them, in full, AT THE TIME OF SERVICE, unless other arrangements are made with the financial department. I acknowledge that should I default on the financial obligation, the dental office shall be entitled to recover all reasonable collection cost, attorney fees, and court cost accrued in collection of the debt. I further acknowledge that the dental office shall be entitled to change interest on my balance past due at the current rate.

I have reviewed my health history with the attending doctor, his assistant, or qualified designate. IfI required changes be made to my health history, they were made in the computer system.

Under Idaho law, Hillary Whipple D.M.D. may use or disclose your personal health information to a family member, friend, or other person involved in your health care if you are present and you do not object or in the event of an emergency; to comply with applicable federal, state or local laws; for public health reasons such as to control diseases; to report a suspected case of abuse, neglect or domestic violence; to comply with health oversight activities related to health care services; to the U.S. Department of Health and Human Services; to law enforcement officials for a law enforcement purpose; to respond to legal process; for purposes of public safety or national security; to allow a funeral director to carry out his or her duties; to allow a coroner or medical examiner to identify you or determine cause of death; or to respond to a request by military command authorities.

YOUR RIGHTS ABOUT YOUR CONFIDENTIAL INFORMATION
Right to review and copy: You have the right to review and copy your information as allowed by law. There may be a fee for copying your records.
Right to amend: You have the right to ask us to make changes to your information if you feel that the information we have about you is wrong or not complete. We may deny your request if you ask us to change information that: a) Was not created by Dr. Hillary Whipple, b) Is not part of the information which you would be allowed to review and copy, c) We determine it to be correct and complete.
Right to restrict health information disclosure: You have the right to ask us not to share your health information for your treatment or services, or normal business purposes. You must tell us what information you do not want us to share and who we should not share it with. If we agree to your request, we will comply unless the information is needed to give you emergency treatment, or until you end the restriction.
Right to an alternate means of delivery: You have the right to ask that we deliver your information to you at a different mailing address.