GENTILE DENTAL CARE


    ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES


    *YOU MAY REFUSE TO SIGN THIS ACKNOWLEDGEMENT

    I,
    have reviewed a copy of the office notices of Privacy Practice.



    Please Print Name
    Signature
    Date

    For Office Use Only



    We attempted to obtain written acknowledgement of receipt of our privacy practices, our
    acknowledgement could not be obtained because:

    Individual refuse to sign


    Communications barriers prohibited obtaining acknowledgement


    An emergency situation prevented us from obtaining acknowledge


    Other (Please specify)


    Gentile_Dental_Care_Logo
    GentileDentalCare

    A prosthodontist is a dentist who specializes in the esthetic restoration and replacement of teeth.

    Our Awards
    Social Networks

    Our staff is professional and courteous with everyone who walks through our doors. We strive to give exemplary care in our practice by communicating with our patients and agreeing on a treatment plan that best suits them aesthetically, and financially.

    Copyright 2020 by BoldThemes. All rights reserved.