HIPAA & appointment policies

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Use and disclosure of health information (HIPAA)

Protected health information is used to carry out treatment/payments, bill insurance, and make referrals. A copy of our Notice of Privacy Practices is available in person at the office or electronically by request.

Please Note: HCPD will not discuss or disclose protected health information to a non-guardian family member without your written consent. This includes siblings, nannies, and/or grandparents. You may designate a non-guardian family member to escort your child to appointments and discuss protected health information by writing the name below. HCPD cannot be held liable for any inaccuracies in the transfer of information when a legal guardian is not present.

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Appointment policies

The mission of Hamilton County Pediatric Dentistry is to create a fun, safe, and enthusiastic dental environment. As such, we schedule longer-than-average appointment times so our team can better interact with our child. We ask parents to follow our appointment policy to help maintain a certain level of predictability in our schedule.

Please read and confirm the following:

A legal guardian is required at all first-appointment visits.

Before/after school appointments are in high demand, we recommend scheduling six months in advance

Short-notice cancellations typically result in re-appointment during school hours

Filling and extraction appointments are scheduled during morning hours

Parents are encouraged to come back with their kids during appointments (exception: sedation appts)

Please make accommodations for other children/siblings if you wish to be back during visits

Children/siblings cannot be left unattended in the waiting room

If you are more than 15 minutes late, we reserve the right to reschedule (resulting in fee)

By signing below, I certify the information provided within this new patient packet is accurate. I have read, understand, and agree to all of the insurance and financial policies, and I give permission to HCPD to bill my insurance company. I assume financial responsibility for my child’s account and agree to pay any remaining balance. I have been offered a copy of the Notice of Privacy Practices, and I give consent for HCPD to use and disclose protected health information to carry out treatment, billing, and healthcare referrals. I have read, understood and agree to all of the appointment policies. I give consent for Dr. Laura Juntgen and the HCPD team to treat my child.

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