Important Patient Policies

We believe in transparency and want to make it easy for you to access and understand our policies. Please review our patient policies below. These policies help ensure high-quality care and clear communication between you and our team. These same policies are included in your online intake forms, where you’ll be asked to review and acknowledge them before your first visit. Feel free to reference this page any time you need to review our policies.

Patient’s Rights

As a patient, I have the right to impartial, reasonable access to care and treatment regardless of one’s race, color, creed, religion, sex, sexual orientation, national origin, disability, age, or status as a disabled veteran. – I have the right to care that is considerate and respectful of their cultural and personal values and beliefs. – I have the right to have reasonable access to a certified interpreter or other language assistance if they do not speak or understand the English language. – I have the right to a reasonably safe and secure environment. – I have the right to be free from all forms of abuse or harassment. – I have the right to be fully informed of my oral health needs and the alternatives for care and to be referred elsewhere when NCOM cannot provide the care a patient requests. – I have the right to consideration for my personal privacy and confidentiality of information. – I have the right to have access to a written statement that articulates my rights and responsibilities as a patient. – I have the right to access my own health information, request amendment to it, and receive an accounting of disclosures about it, as permitted under applicable law. – I have the right to request and receive an itemized and detailed explanation of their bill for services rendered. – I can expect that services rendered at NCOM meet the standard of care of the medical and dental profession. – I have the right to be informed of outcomes of care, treatment, and services, including unanticipated outcomes. – I and/or my legally authorized surrogate decision maker(s) have the right, in collaboration with my provider, to be informed and make decisions involving my care, including the right to accept or to refuse treatment and to be informed of the consequences of such refusal.

Privacy and Sharing of Information

I authorize the clinic and its associated health professionals to collect my personal and medical information as documented above. In addition, I authorize the clinic and its associated health professionals to communicate with my family doctor and/or referring doctor as deemed necessary for my beneficial treatment. I also understand that my personal and medical information is confidential and will only be disclosed to third parties with my permission. This includes SMS messaging which will also not be shared with third parties. 

Cancellation policy

Your appointment time is reserved just for you. A late cancellation or missed visit leaves a hole in the provider’s day that could have been filled by another patient. As such, we require 24 hours notice for any cancellations or changes to your appointment. Patients who provide less than 24 hours notice, or miss their appointment, will be charged a $100 cancellation fee to the card on file.

SMS Terms & Conditions:

Upon filling out your intake form, you may elect to receive text messages for appointment notifications and reminders with customizable time intervals. 

I consent to receive SMS from Northwest Center for Oral Medicine. Your SMS information will never be shared with a third party. You may opt out at any time. Reply STOP to opt-out; Reply HELP for help. Message and data rates apply. Messaging frequency may vary. 

Please see our SMS Privacy and Terms and Conditions for more details.