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Ipswich Orthodontics > Patient information > Patient forms > Record release consent

Record release consent

In accordance with the Privacy Act 2000, your written consent must be obtained before confidential information contained in your dental records may be released to another party. Your privacy is important to us. The privacy act contains a set of principals for handling personal information in a confidential and secure manner. We will only release your personal information to other Health care providers for care and continuation of your Orthodontic treatment, while you are being treated with us.

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I do/do not consent to the release of my/my child’s (if under 16yrs of age) dental records to my /my child’s dental practitioner / dental specialists/ medical practitioner, during the time being treated by Ipswich Orthodontics.

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Australian Dental Association

Royal Australian College of Dental Surgeons

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Australian Society of Orthodontists

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Ipswich Orthodontics

13 South Street
Ipswich
QLD 4305

07 3812 0865

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