IGO Dental & Implant Center

HIPAA Authorization

Last updated: May 20, 2026

This is a general statement of how IGO Dental & Implant Center handles your protected health information. A printed copy of our complete Notice of Privacy Practices is available at the office on request.

What this authorization is for

This page describes your authorization for IGO Dental & Implant Center (“we” or “the practice”) to collect, use, and disclose your protected health information (PHI) for treatment, payment, and routine healthcare operations as defined by the Health Insurance Portability and Accountability Act (HIPAA) and 45 CFR Part 164.

Information this covers

This authorization applies to information we collect or create about you in connection with your care, including: your name and contact information, dental and medical history, examination findings, treatment plans, X-rays and clinical photographs, prescriptions, billing and insurance records, and any other information related to the care we provide.

How we may use or disclose your information

By checking the HIPAA Authorization box on our booking form, you authorize us to use and disclose your PHI for the following purposes:

• Treatment: to provide and coordinate your dental care, including communicating with other healthcare providers involved in your treatment (such as specialists, primary care physicians, or laboratories).
• Payment: to verify your insurance coverage, submit claims to your insurance carrier, and bill you or your responsible party for services rendered.
• Healthcare operations: to run our practice, including quality assessments, staff training, accreditation reviews, and general business activities. This includes the use of Lucy AI, our AI receptionist (operated by Prometheus AI Labs as a HIPAA business associate of the practice), to handle both inbound communications (calls, chats, SMS) and outbound communications (appointment reminders, confirmations, recall outreach, no-show follow-ups, post-treatment check-ins, and ad-lead callbacks), transcribe conversations, and hand off context to our staff.

How long this lasts

This authorization remains in effect for as long as you are a patient of the practice, unless you revoke it in writing.

Your right to revoke

You may revoke this authorization at any time by submitting a written request to IGO Dental & Implant Center at 512 E Southern Ave, Suite 101, Tempe, AZ 85282, or by speaking with our HIPAA Privacy Officer at (602) 999-8888. Revocation will not affect any actions we took in reliance on your authorization before we received your written notice.

Your rights under HIPAA

• Inspect and request a copy of your PHI.
• Request amendments to your PHI.
• Request restrictions on how we use or disclose your PHI.
• Request confidential communications (for example, asking us to contact you only at a particular phone number).
• Receive an accounting of certain disclosures of your PHI.
• File a complaint with us or with the U.S. Department of Health & Human Services Office for Civil Rights if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.

Re-disclosure

Once we disclose your PHI to a third party (for example, an insurance carrier or another healthcare provider), that recipient may re-disclose the information, and HIPAA protections may no longer apply to it.

Treatment is not conditioned on this authorization

You are not required to sign this authorization in order to receive dental treatment at IGO Dental & Implant Center; however, your insurance carrier may require certain disclosures for payment to be processed.