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Patient Policies

Please click below to review our patient policies that we have in place across Cumberland Pediatric Dentistry & Orthodontic locations.

HIPAA Authorization for Release of Health Information
Acknowledgment of Receipt of HIPAA Privacy Practices
Authorization Request for Restrictions and Confidential Communications
Notice Of Privacy Practices
Non-Discrimination Policy
Good Faith Estimate
Notice of Privacy Practices (Spanish)
Privacy Practices (Continued)

If you need any of the forms in an additional language, please contact your local office.