The information collected on this form is stored in a computerized file by Mr. Sadeghi Ramin (7901 4th St N, Suite 300, St. Petersburg, FL 33702), who can be reached at info@meditel-dentaire.com. We use this information to manage patient and customer inquiries.

We collect this information with your consent in order to respond to your requests and to comply with our legal obligations.

The data collected will be shared only with our patient care coordinators and relevant internal staff.

We retain your data according to the following schedule:

• For our patients: Medical and dental records are kept for a minimum of seven years following the last date of service, in accordance with federal and state regulations.
• For prospective patients: Information is retained for three years from our last contact with you.

You have the right to access your personal information, request corrections, and ask for its deletion, subject to our legal and professional obligations to maintain patient records.

You may withdraw your consent to the processing of your data at any time.

To learn more about your rights regarding protected health information, you can visit the U.S. Department of Health & Human Services website.

To exercise these rights or for any questions about the processing of your data in this system, you can contact Mr. Sadeghi Ramin at the following address: info@meditel-dentaire.com.

If you feel, after contacting us, that your privacy rights have not been respected, you may file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.