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Patient Forms

Help us get to know your child!

Please take a moment to fill out our patient information form. If you have any questions along the way, feel free to contact our practice. Please select a link below for your location:

We look forward to meeting you and your son or daughter at your first appointment.


 

Privacy Policy & SMS Terms and Conditions

Effective Date: 1/1/2026

1. Overview

Smiling Sea Pediatric Dentistry & Orthodontics (“we,” “us,” or “our”) is committed to protecting the privacy and security of our patients’ and families’ personal and health information. This Privacy Policy explains how we collect, use, disclose, and safeguard information when you interact with us, including through our website, phone calls, SMS/text messaging, patient portals, and in‑office services.

This policy complies with applicable privacy laws, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and SMS communication requirements established by U.S. mobile carriers.


2. Information We Collect

a. Personal and Identifiable Information

  • Patient or parent/guardian name
  • Mobile phone number
  • Email address
  • Mailing address
  • Date of birth
  • Insurance information
  • Emergency contact details

b. Protected Health Information (PHI)

  • Dental and orthodontic treatment information
  • Appointment details
  • Treatment plans and clinical notes
  • Billing and insurance records

c. SMS Communication Data

  • Mobile phone number
  • Message content related to appointments, billing, or care coordination
  • Message delivery status, timestamps, and opt‑in/opt‑out records

d. Website and Technical Information

  • IP address
  • Browser and device type
  • Website usage data (cookies or analytics, if applicable)

3. How We Use Your Information

We use your information to:

  • Provide dental and orthodontic care
  • Schedule and manage appointments
  • Send appointment reminders, confirmations, and office notifications
  • Communicate about billing, insurance, and care coordination
  • Respond to inquiries and provide customer support
  • Maintain compliance with healthcare and legal obligations

SMS messages may include conversational and informational content. Promotional messages, if any, will be clearly identified. Messaging frequency may vary.


4. HIPAA Notice

We comply with HIPAA requirements regarding the use and disclosure of Protected Health Information (PHI). PHI is used only for treatment, payment, healthcare operations, or as otherwise permitted or required by law. Additional details regarding your HIPAA rights are available in our Notice of Privacy Practices.


5. SMS Terms & Conditions

a. SMS Program Description

Smiling Sea Pediatric Dentistry & Orthodontics may send SMS messages for the following purposes:

  • Appointment reminders and confirmations
  • Scheduling or rescheduling notifications
  • Office updates and care coordination
  • Billing or insurance communications
  • Limited practice‑related updates

b. Consent to Receive SMS Messages

If you consent to receive conversational, informational, and/or promotional SMS messages from Smiling Sea Pediatric Dentistry & Orthodontics, you agree to receive conversational, informational, and/or promotional SMS messages from us.

Consent to receive SMS messages:

  • Is not a condition of treatment or payment
  • May be withdrawn at any time
  • Applies only to communications from Smiling Sea Pediatric Dentistry & Orthodontics

c. Message Frequency

Messaging frequency may vary based on your interaction with our office and your care needs.

d. Message and Data Rates

Message and data rates may apply depending on your mobile carrier and plan.

e. Opt‑Out Instructions

You may opt out of SMS messages at any time by replying STOP to any message. After opting out, you will no longer receive SMS messages unless you re‑enroll.

f. Help and Support

For support, reply HELP to any message or contact us directly using the information listed below.

g. Privacy of Mobile Information

  • No mobile opt‑in or text message consent will be shared with third parties or affiliates.
  • Mobile information will not be sold, rented, or shared for marketing or promotional purposes.
  • SMS communications may be delivered through trusted service providers (such as RingCentral) who are contractually obligated to protect your data.

6. Information Sharing and Disclosure

We do not sell or rent personal information.

We may share information only:

  • With trusted service providers supporting our operations and communications
  • As required by law, regulation, or legal process
  • To protect the rights, safety, and property of our patients, staff, and practice

7. Data Security

We maintain reasonable administrative, technical, and physical safeguards designed to protect personal information and PHI from unauthorized access, disclosure, alteration, or destruction.


8. Data Retention

We retain personal and health information only as long as necessary to provide care, meet legal requirements, and comply with healthcare record retention laws.


9. Your Rights

You or your authorized representative may have the right to:

  • Request access to personal or health information
  • Request corrections to inaccurate records
  • Request restrictions on certain uses or disclosures
  • Withdraw consent for SMS communications

Requests may be submitted using the contact information below.


10. Children’s Privacy

Our services are provided to pediatric patients with the consent and involvement of a parent or legal guardian. We do not knowingly collect personal information from children without parental authorization.


11. Changes to This Policy

We may update this Privacy Policy & SMS Terms and Conditions periodically. Changes will be posted on our website with an updated effective date.


12. Contact Us

If you have questions about this Privacy Policy, HIPAA practices, or SMS communications, please contact us:

Smiling Sea Pediatric Dentistry & Orthodontics
Phone: (818) 991‑0978, (818) 783-4565
Email: info@smilingseadentists.com
Address: 394 Lombard Street, Thousand Oaks, CA 91360

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