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The information you submit is protected under the Health Insurance Portability and Accountability Act (HIPAA). Your personal and health information will be used only to schedule and coordinate your dental care. We will never sell your information or share it without your written authorization, except as required by law or for treatment, payment, and healthcare operations.

By submitting this form, you acknowledge receipt of our Notice of Privacy Practices. To exercise your HIPAA rights or report a privacy concern, call us at (770) 478-1001 or email info@highmarkcares.com.