Medical History Form – North
Medical History Form – North
Privacy of your personal health information is an important part of our office providing you with quality
dental care. We understand the importance of protecting your personal health information. We are
committed to collecting, using, and disclosing your personal health information responsibly. We also try
to be as open and transparent as possible about the way we handle your personal health information. It
is important to us to provide this service to our patients.
In this office, Dr. Nagham is the contact person for personal health information-related matters.
All staff members who come in contact with your personal health information are aware of the sensitive
nature of the information that you have disclosed to us. They are all trained in the appropriate uses and
protection of your information. Attached to this consent form, we have outlined what our office is doing
to ensure that:
College of Dental Surgeons of Ontario, and the law.
Do not hesitate to discuss our policies with me or any member of our office staff.
How Our Office Collects, Uses, and Discloses Patients’ Personal Health Information
Our office understands the importance of protecting your personal health information. To help you
understand how we are doing that, we have outlined here how our office is using and disclosing your
information.
This office will collect, use and disclose personal health information about you for the following
purposes:
By signing the consent section of this Patient Consent Form, you have agreed that you have given your
informed consent to the collection, use, and/or disclosure of your personal health information for the
purposes that are listed. If a new purpose arises for the use and/or disclosure of your personal health
information, we will seek your approval in advance.
Your personal health information may be accessed by regulatory authorities under the terms of the
Regulated Health Professions Act (RHPA) for the Royal College of Dental Surgeons of Ontario fulfilling its mandate under the RHPA.
You may withdraw your consent for the use or disclosure of your personal health information at any time.
Patient Consent
I have reviewed the above information that explains how your office will use my personal health
information, and the steps your office is taking to protect my information.
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Dentist
Dr. Nagham Altalib graduated from dental school, Baghdad University, Iraq, in 1998. After finishing her internship, she started practicing dentistry in a prosthodontics specialized academic center in Baghdad.
In 2007, she moved with her family to Dubai, UAE. She joined the DHCC European University team for Implants and Orthodontics. Her role was to diagnose orthodontic needs for children. That was a major research project to promote and improve oral hygiene for children in Dubai.
In 2010, she commenced her journey in Canada. Following her training and multiple exams, she was NDEB certified and started to practice dentistry.
London was the city she decided to live and practice in with her family. She started as an associate dentist, but soon she decided to establish her own practice.
Dr. Altalib’s experience and patience with child-dentistry came from her motherhood, as she is a mother for two kids. Her areas of expertise include Orthodontics, Prosthodontics, and Cosmetic dentistry. In her free time, she always spends her time with family and friends.