BlissDental Your Kendall General Dentist

(305) 274-6500

  • Dental Services
    • General
      • Cleanings
      • Dental Checkup
      • Emergency Dentist
      • Laser Dentistry
      • Pediatric Dental
      • Sedation Dentist
      • Full Mouth Reconstruction
      • Tooth Extraction
    • Restorative
      • All-on-4 Dental Implants
      • Dental Crowns and Bridges
      • Dental Implants
      • Dental Restorations
      • Full & Partial Dentures
      • Tooth Fillings
    • Cosmetic
      • Dental Veneers
      • Invisalign® Dentist
      • Smile Makeover
      • Zoom Teeth Whitening
    • Other
      • Botox
      • Juvéderm
  • About Us
    • Patient Form
    • Testimonials
    • Specials
    • Our Team
  • Gallery
    • Photo Gallery
    • Video Gallery
  • Pay Here
  • Contact Us
BlissDental Your Kendall General Dentist
  • Dental Services
    • General
      • Cleanings
      • Dental Checkup
      • Emergency Dentist
      • Laser Dentistry
      • Pediatric Dental
      • Sedation Dentist
      • Full Mouth Reconstruction
      • Tooth Extraction
    • Restorative
      • All-on-4 Dental Implants
      • Dental Crowns and Bridges
      • Dental Implants
      • Dental Restorations
      • Full & Partial Dentures
      • Tooth Fillings
    • Cosmetic
      • Dental Veneers
      • Invisalign® Dentist
      • Smile Makeover
      • Zoom Teeth Whitening
    • Other
      • Botox
      • Juvéderm
  • About Us
    • Patient Form
    • Testimonials
    • Specials
    • Our Team
  • Gallery
    • Photo Gallery
    • Video Gallery
  • Pay Here
  • Contact Us
(305) 274-6500
Contact Us

HIPAA Compliance Patient Consent Form

Our Notice of Privacy Practices provides information about how we may use or disclose protected health information.

The notice contains a patient’s rights section describing your rights under the law. You ascertain that by your signature that you have reviewed our notice before signing this consent.

The terms of the notice may change, if so, you will be notified at your next visit to update your signature/date.

You have the right to restrict how your protected health information is used and disclosed for treatment, payment or healthcare operations. We are not required to agree with this restriction, but if we do, we shall honor this agreement. The HIPAA (Health Insurance Portability and Accountability Act of 1996) law allows for the use of the information for treatment, payment, or healthcare operations.

By signing this form, you consent to our use and disclosure of your protected healthcare information and potentially anonymous usage in a publication. You have the right to revoke this consent in writing, signed by you. However, such a revocation will not be retroactive.

By signing this form, I understand that:

  • Protected health information may be disclosed or used for treatment, payment, or healthcare operations.
  • The practice reserves the right to change the privacy policy as allowed by law.
  • The practice has the right to restrict the use of the information but the practice does not have to agree to those restrictions.
  • The patient has the right to revoke this consent in writing at any time and all full disclosures will then cease.
  • The practice may condition receipt of treatment upon execution of this consent.

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BlissDental Your Kendall General Dentist

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5 stars from 275 reviews

Contact Info

  • 8501 SW 124th Ave Ste 104
    Kendall, FL 33183
  • Phone: (305) 274-6500
Pay Here

Hours of Operation

Monday: 9:00AM to 5:00PM
Tuesday: 9:00AM to 7:00PM
Wednesday: 9:00AM to 5:00PM
Thursday: 9:00AM to 5:00PM
Friday: 9:00AM to 5:00PM
Saturday: 8:00AM to 2:00PM *
Sunday: Closed

*first Saturday of the month