DISCLAIMER

This disclaimer outlines the terms and conditions governing the use of the Dentist Referral Form provided by Childers Ortho for the purpose of referring patients to our orthodontic practice. By submitting referrals through this form, you agree to abide by these terms. If you do not agree with these terms, please refrain from using the referral form.

Referral Purpose: The Dentist Referral Form is intended solely for the purpose of referring patients to Childers Ortho for orthodontic evaluation and potential treatment. The information provided should include suggestions for specific issues to be addressed during the patient's orthodontic assessment.

Patient Privacy: We highly value patient privacy and confidentiality. Any information submitted through the Dentist Referral Form, including patient names, contact details, and relevant dental information, will be used solely for the purpose of evaluating the referral and providing orthodontic services. We do not share this information with third parties without explicit consent.

Professional Recommendations: The information and suggestions provided in the referral form by the referring dentist are valuable for the evaluation process. However, Childers Ortho retains the right to conduct its own assessments and treatment planning based on its expertise and professional judgment.

Communication: Referral submissions through this form will be sent to Childers Ortho via email. While we take precautions to secure our communication channels, please understand that email communication may not be entirely secure. Refrain from including sensitive or personal health information in your submissions.

Data Security: We employ measures to protect the confidentiality and security of the information transmitted through the referral form. However, Childers Ortho is not responsible for any breaches of security that may occur during the transmission of data.

Use of Information: The information provided in the referral form will be used solely for the purpose of evaluating the referred patient's orthodontic needs and potential treatment options. It may also be used for internal record-keeping and communication purposes.

Changes to Terms: This disclaimer may be subject to change without prior notice. It is your responsibility to review and understand its content each time you submit a referral through the form.

By submitting referrals through the Dentist Referral Form provided by Childers Ortho, you acknowledge and agree to the terms outlined in this disclaimer. Please review this disclaimer periodically for any updates or changes.

If you have any questions or concerns about this disclaimer or the referral process, please contact Childers Ortho for clarification.