This Financial Contract is a legal agreement between you and Midtown Dental. Please read it carefully before signing it. If you have any questions, contact us or ask someone you trust to explain it to you. While we will make every effort to work with Medicaid and any other insurance you may have, you as the patient are ulitimately responsible for payment.
This Notice of Privacy Practices explains how we will keep your private health information confidential. It explains who we may share your information with, and why. If you have any questions, please contact us, or ask someone you trust to explain it to you.
This Privacy Acknowledgement form signifies that you have read the Notice of Privacy Practices form listed above, and have accepted its terms.