Bookings and Appointments
Effective scheduling allows our office to operate efficiently and respect the time of each patient’s appointment.  Your time is valuable to us, so please be considerate of the time reserved for you.
Your next appointment will be scheduled for you in advance so that we may reserve preferred appointment times for our patients.  As an added courtesy, you will receive a "Smile Reminder".

Smile Reminders
We use a state of the art system to send you a voicemail, e-mail, text message or if you prefer even a friendly phone call to remind you of your appointment.

Medical History Form
Print the form in PDF.

Privacy Policy
Please print the form below or download and print the form in PDF.

Patient Consent Form
Personal Information
We are aware of the sensitive and personal nature of the information that our patients disclose to us.  An important part of our job is to responsibly protect your personal information as it is collected, utilized and disclosed.
Dr. Janet S. Leith acts as the Privacy Information Officer and all staff members who come in contact with your personal information are aware of the sensitive nature of the information. They are all trained in the appropriate uses and protection of this information.
Our office ensures that:
• only necessary information is collected about you;
• the sharing of information is done only with your consent;
• the storage, retention and destruction of your personal information complies with existing legislation, and privacy protection protocols;
• our privacy protocols comply with privacy legislation, standards of our regulatory body, the Royal College of Dental Surgeons of Ontario, and the law.

If you have any questions or concerns on our patient information policy do not hesitate to discuss them with any staff member.

Collection, Uses and Disclosure of Patients' Personal Information
Our office will collect, use and disclose information about you for the following purposes:
• to deliver safe and efficient patient care
• to provide continuous high quality service
• to assess your health needs
• to provide health care
• to advise you of treatment options
• to enable us to contact you
• to establish and maintain communication with you
• to offer and provide treatment, care and services in relationship to the oral and maxillofacial complex and dental care generally
• to communicate with other treating health-care providers, including specialists and general dentists who are the referring dentists and /or peripheral dentists
• to allow us to maintain communication and contact with you to distribute health-care information and to book and confirm appointments
• to allow us to efficiently follow-up for treatment, care and billing
• for teaching and demonstrating purposes on an anonymous basis
• to complete and submit dental claims for third party adjudication and payment
• to comply with legal and regulatory requirements, including the delivery of patients' charts and records to the Royal College of Dental Surgeons of Ontario in a timely fashion, when required, according to the provisions of the Regulated Health Professions Act
• to comply with agreements/undertakings entered into voluntarily by the member with the Royal College of Dental Surgeons of Ontario, including the delivery and/or review of patients' charts and records to the College in a timely fashion for regulatory and monitoring purposes
• to permit potential purchasers, practice brokers or advisors to evaluate the dental practice
• to allow potential purchasers, practice brokers or advisors to conduct an audit in preparation for practice sale
• to deliver your charts and records to the dentist's insurance carrier to enable the insurance company to assess liability and quantify damages, if any
• to prepare materials for the Health Professions Appeal and Review Board (HPARB)
• to invoice for goods and services
• to process credit card payments
• to collect unpaid accounts
• to assist this office to comply with all regulatory requirements
• to comply generally with the law

Patient Consent Form
By signing the consent section of this Patient Consent Form, you have agreed that you have given your informed consent to the collection, use and/or disclosure of your personal information for the purposes that are listed above. If a new purpose arises for the use and/or disclosure of your personal information, we will seek your approval in advance.
Your information may be accessed by the regulatory authorities under the terms of the Regulated Health Professions Act (RHPA) for the purposes of the Royal College of Dental Surgeons of Ontario fulfilling its mandate under the RHPA, and for the defense of a legal issue.
Our office will not under any conditions supply your insurer with your confidential medical history. In the event this kind of request is made, we will forward the information directly to you for review, and for your specific consent.
When unusual requests are received, we will contact you for the permission to release such information. We may also advise you if such a release is inappropriate.
You may withdraw your consent for use or disclosure of your personal information, and we will explain the ramifications of that decision, and the process.

Patient Consent Form
I have reviewed the above information that explains how your office will use my personal information, and the steps your office is taking to protect my information.
I know that your office has a Privacy Code, and I can ask to see the Code at any time.
I agree that Dr. Janet S. Leith can collect, use and disclose personal information about X_______________________________ as above in the information about the office's privacy policies.
Print Name
____________________________________________________________
X________________________________ X Date_____________________
Print Name
X_______________________________ X __________________________
Signature Signature of Witness