For new patients please arrive at Trussmile Dental in North Quincy at least 10 minutes early for paperwork. You may elect not to have radiographs taken at our office if you have a copy of previous radiographs less than 2 years old. We often request a copy of your previous dental records if you have a more in depth dental history. For patients requesting records from our office, we process requests in 2-3 of our business days. We kindly request 24 hours in case you need to cancel or reschedule your appointment.
Caregivers (of legal age) of senior/ elderly patients (or any adult) needing assistance are required to be present for the entire appointment.
PATIENT FORMS
New patient form
Consent Form
Notice of privacy practices
Updated September 2025
This notice describes how medical and dental information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Our Responsibilities
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We are required by law to maintain the privacy of your health information.
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We will provide you with a copy of this Notice.
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We must follow the terms of this Notice currently in effect.
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We will notify you if a breach occurs that may have compromised the privacy of your information.
How We May Use and Share Your Information
We may use or disclose your health information in the following ways:
For Treatment
We may use your information to provide, coordinate, or manage your dental care and related services. For example, we may share your information with specialists or laboratories involved in your care.
For Payment
We may use and disclose your information to obtain payment for services we provide. For example, we may share information with your dental insurance company.
For Health Care Operations
We may use your information to run our practice, improve services, and ensure quality care. For example, reviewing staff performance or training dental students.
Other Uses and Disclosures Allowed by Law
We may also share information without your written permission in certain situations, including:
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Public health reporting (disease prevention, reporting adverse events, product recalls).
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Law enforcement and legal proceedings (in response to a court order, subpoena, or other lawful process).
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Health oversight activities (audits, inspections, investigations).
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To prevent a serious threat to your health or safety or the health and safety of others.
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Special government functions (such as military or national security).
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Workers’ compensation claims.
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Coroners, medical examiners, and funeral directors when necessary.
Uses and Disclosures That Require Your Authorization
We will not use or disclose your health information for the following purposes without your written authorization:
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Marketing purposes.
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Sale of your information.
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Most sharing of psychotherapy notes (not typical in dental care).
If you authorize us to share your information, you may revoke that authorization in writing at any time.
Your Rights Regarding Your Health Information
You have the right to:
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Inspect and obtain a copy of your health information.
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Request corrections if you believe your information is incomplete or incorrect.
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Request restrictions on how we use or disclose your information (though we may not be required to agree).
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Request confidential communications (for example, asking us to contact you at a different phone number or address).
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Receive an accounting of disclosures showing when your information has been shared for reasons other than treatment, payment, or operations.
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Obtain a paper copy of this Notice at any time, even if you received it electronically.
Changes to This Notice
We reserve the right to change this Notice at any time. Any changes will apply to all information we maintain. A current copy will always be available in our office and on our website.
Questions or Complaints
If you have questions about this Notice or believe your privacy rights have been violated, you may contact us at:
Privacy Officer: Gail Fernando
(617)328-4600