3930 Pender Drive. Suite 220. Fairfax. VA 22030.

My Fairfax Dental Office Policies

At My Fairfax Dental, Our goal is to provide the highest quality of dental care possible to children and Family, to that end we have clear communication of our financial policy.

 

ALL ACCOUNTS ARE DUE AND PAYABLE AT TIME OF SERVICE.

 

If a procedure requires multiple appointments, payment is required in full at the first appointment.

The Patient is fully responsible for all fees charged by our office regardless of your insurance coverage.

Our Payment Options
We accept the following payment options:

  1. Cash
  2. Check* (Only for established patients)
  3. Debit card
  4. Credit card (MasterCard, Visa and Amex)
  5. CareCredit Flexible Finance
  6. Lending Club Flexible Finance

*Checks are not accepted for new patients and emergency patients.

Patient with insurance
As a courtesy to you, our office will submit claims to your insurance provider. If for any reason the claims go unpaid you will be responsible for all charges. The patient is responsible for the estimated non-covered portion, procedures and/or deductibles at the time of the service.

 

All Children must be accompanied by their Parents to receive treatment.

 

Parents accompanying their children are financially responsible for payment and must make prior arrangements for payment (cash or credit card authorization).

Cancellation Policy
Please note that once you have an appointment, we make every effort to reserve that time especially for you. Should you, for any reason, find that you must cancel or reschedule your appointment, we ask that you give us at least 48 hours notice in order to avoid a late cancellation fee.
At My Fairfax Dental, we value our patients and are very careful in the way we safeguard personal health information. Our HIPAA Privacy Notice describes our policies concerning health information and our commitment to protect the privacy of our patients
This Privacy Policy governs the manner in which [MY FAIRFAX DENTAL] collects, uses, maintains and discloses information collected from users (each, a “User”) of the MyFairfaxDental.com website (“Site”). This privacy policy applies to the Site and all products and services offered by [MY FAIRFAX DENTAL].

 

Personal identification information

We may collect personal identification information from Users in a variety of ways, including, but not limited to, when Users visit our site, subscribe to the newsletter, respond to a survey, fill out a form, and in connection with other activities, services, features or resources we make available on our Site. Users may be asked for, as appropriate, name, email address, phone number. Users may, however, visit our Site anonymously. We will collect personal identification information from Users only if they voluntarily submit such information to us. Users can always refuse to supply personally identification information, except that it may prevent them from engaging in certain Site related activities.

 

Non-personal identification information

We may collect non-personal identification information about Users whenever they interact with our Site. Non-personal identification information may include the browser name, the type of computer and technical information about Users means of connection to our Site, such as the operating system and the Internet service providers utilized and other similar information.

 

Web browser cookies

Our Site may use “cookies” to enhance User experience. User’s web browser places cookies on their hard drive for record-keeping purposes and sometimes to track information about them. User may choose to set their web browser to refuse cookies, or to alert you when cookies are being sent. If they do so, note that some parts of the Site may not function properly.

 

How we use collected information

[MY FAIRFAX DENTAL] may collect and use Users personal information for the following purposes:
– To improve customer service
Information you provide helps us respond to your customer service requests and support needs more efficiently.
– To personalize user experience
We may use information in the aggregate to understand how our Users as a group use the services and resources provided on our Site.
– To improve our Site
We may use feedback you provide to improve our products and services.
– To run a promotion, contest, survey or other Site feature
To send Users information they agreed to receive about topics we think will be of interest to them.
– To send periodic emails
We may use the email address to send User information and updates pertaining to their order. It may also be used to respond to their inquiries, questions, and/or other requests. If User decides to opt-in to our mailing list, they will receive emails that may include company news, updates, related product or service information, etc. If at any time the User would like to unsubscribe from receiving future emails, we include detailed unsubscribe instructions at the bottom of each email or User may contact us via our Site.

 

How we protect your information

We adopt appropriate data collection, storage and processing practices and security measures to protect against unauthorized access, alteration, disclosure or destruction of your personal information, username, password, transaction information and data stored on our Site.

 

Sharing your personal information

We do not sell, trade, or rent Users personal identification information to others. We may share generic aggregated demographic information not linked to any personal identification information regarding visitors and users with our business partners, trusted affiliates and advertisers for the purposes outlined above.We may use third party service providers to help us operate our business and the Site or administer activities on our behalf, such as sending out newsletters or surveys. We may share your information with these third parties for those limited purposes provided that you have given us your permission.

 

Third party websites

Users may find advertising or other content on our Site that link to the sites and services of our partners, suppliers, advertisers, sponsors, licensors and other third parties. We do not control the content or links that appear on these sites and are not responsible for the practices employed by websites linked to or from our Site. In addition, these sites or services, including their content and links, may be constantly changing. These sites and services may have their own privacy policies and customer service policies. Browsing and interaction on any other website, including websites which have a link to our Site, is subject to that website’s own terms and policies.

 

Google Adsense

Some of the ads may be served by Google. Google’s use of the DART cookie enables it to serve ads to Users based on their visit to our Site and other sites on the Internet. DART uses “non personally identifiable information” and does NOT track personal information about you, such as your name, email address, physical address, etc. You may opt out of the use of the DART cookie by visiting the Google ad and content network privacy policy at http://www.google.com/privacy_ads.html

 

Changes to this privacy policy

[MY FAIRFAX DENTAL] has the discretion to update this privacy policy at any time. When we do, we will revise the updated date at the bottom of this page. We encourage Users to frequently check this page for any changes to stay informed about how we are helping to protect the personal information we collect. You acknowledge and agree that it is your responsibility to review this privacy policy periodically and become aware of modifications.

 

Your acceptance of these terms

By using this Site, you signify your acceptance of this policy and terms of service. If you do not agree to this policy, please do not use our Site. Your continued use of the Site following the posting of changes to this policy will be deemed your acceptance of those changes.

 

Contacting us

If you have any questions about this Privacy Policy, the practices of this site, or your dealings with this site, please contact us at:
[MY FAIRFAX DENTAL]
MyFairfaxDental.com
3930 Pender Drive. Fairfax. VA 22030
571-969-3368
info@myfairfaxdental.com

 

This document was last updated on Jan 01, 2017

This notice describes how health information about you may be used and disclosed, and how you can get access to this information.Please review it carefully. The privacy of your health information is important to us.
Our duty

  1. We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices that are described in this Notice while it is in effect. This Notice takes effect 1/1/03, and will remain in effect until we replace it.
  2. We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our Notice effective for all health information that we maintain, including health information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this Notice and make the new Notice available upon request.
  3. You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information listed at the end of this notice.

Uses and disclosures of health info
We use and disclose health information about you for treatment, payment, and healthcare operations. For example:

  1. Treatment: We may use or disclose your health information to a dentist, physician, or other healthcare provider providing treatment to you.
  2. Payment: We may use and disclose your health information to obtain payment for services we provide to you.
  3. Healthcare Operations: We may use and disclose your health information in connection with our healthcare operations. Healthcare operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing, or credentialing activities.
  4. Your Authorization: In addition to our use of your health information for treatment, payment, or healthcare operations, you may give us written authorization to use your health information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those described in this Notice.
  5. To Your Family and Friends: We must disclose your health information to you, as described in the Patient Rights section of this Notice. We may disclose your health information to a family member, friend, or other person to the extent necessary to help you with your healthcare or with payment for your healthcare, but only if you agree that we may do so.
  6. Persons Involved In Care: We may use or disclose health information to notify, or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location, your general condition, or death. If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to such uses or disclosures. In the event of your incapacity or emergency circumstances, we will disclose health information based on a determination using our professional judgment, disclosing only health information that is directly relevant to the person’s involvement in your healthcare. We will also use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays, or other similar forms of health information.
  7. Marketing Health-Related Services: We will not use your health information for marketing communications without your written authorization.
  8. Required By Law: We may disclose your health information when we are required to do so by law.
  9. Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. We may disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health or safety of others.
  10. National Security: We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities. We may disclose to correctional institution or law enforcement official having lawful custody of protected health information of inmate or patient under certain circumstances.
  11. Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, postcards, or letters).

Patient rights

  1. Access: You have the right to look at or get copies of your health information, with limited exceptions. You may request that we provide copies in a format other than photocopies. We will use the format you request unless we cannot practicably do so. You must make a request in writing to obtain access to your health information. You may obtain a form to request access by using the contact information listed at the end of this Notice. We will charge you a reasonable cost-based fee for expenses such as copies and staff time.
  2. Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes, other than treatment, payment, healthcare operations, and certain other activities, for the last 6 years. If you request this accounting more than once in a 12-month period, we may charge you a reasonable cost- based fee for responding to these additional requests.
  3. Restriction: You have the right to request that we place additional restrictions on our use or disclosure of your health information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency).
  4. Alternative Communication: You have the right to request that we communicate with you about your health information by alternative means or to alternative locations. You must make your request in writing. Your request must specify the alternative means or location, and provide satisfactory explanation how payments will be handled under the alternative means or location you request.
  5. Amendment: You have the right to request that we amend your health information. Your request must be in writing, and it must explain why the information should be amended. We may deny your request under certain circumstances.
  6. Electronic Notice: If you receive this Notice on a Web site or by electronic mail (e-mail), you are entitled to receive this Notice in written form.

Questions

  1. If you want more information about our privacy practices or have questions or concerns, please contact us.
  2. If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your health information or in response to a request you made to amend or restrict the use or disclosure of your health information or to have us communicate with you by alternative means or at alternative locations, you may complain to us using the contact information listed at the end of this Notice. You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request.
  3. We support your right to the privacy of your health information. Any questions please contact us at:

Telephone: 571-969-3368 / E-mail: info@myfairfaxdental.com /  Address: My Fairfax Dental, 3930 Pender Drive, Suite 220, Fairfax, VA 22030

 

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