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.

Field marked with * is required

Of

Address

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.

By clicking submit, you are agreeing to our privacy policy

Book an orthodontic consultation

  • No-obligation meeting to discuss your options
  • Meet with one of our Treatment Coordinators
  • Find out about our payment plans

By clicking submit, you are agreeing to our privacy policy

Australian Dental Association

Royal Australian College of Dental Surgeons

Damon Smile

Australian Society of Orthodontists

Invisalign

Insignia

Ipswich Orthodontics

13 South Street
Ipswich
QLD 4305

07 3812 0865

Contact us