Public >> Statement of Patient Rights & Responsibilities

Statement of Patient Rights & Responsibilities

As a patient, your rights include:

  • A written copy of your rights
  • Confidentiality of all your records (Notice of Privacy Practices)
  • A copy of your medical record
  • A timely response to requests, concerns, or complaints
  • To know the name of the faculty member, resident, or student in charge of your care
  • Access to care without regard to race, color, national origin, age, disability, identity, or sex (Notice of Nondiscrimination)
  • Access to aids and free services to help you communicate effectively, including qualified sign language interpreters and written information in other formats (e.g., large print, accessible electronic formats)
  • Access to free language services if your primary language is not English, including qualified interpreters and information written in other languages

If you need language services, contact the TUSDM Office of Patient Relations at 617-636-6998 or If you believe that TUSDM has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, identity, or sex, you can file a grievance with the TUSDM Compliance Office (

As a patient you have certain responsibilities, including:

  • Providing your complete and accurate health history
  • Asking questions and understanding your treatment plan
  • Keeping your appointments and being on time
  • Paying for your treatment at the time of service
  • Respecting the rights, property, and privacy of others

We reserve the right to decline you as a patient when:

  • You (or responsible third party) are unable to finance a reasonable plan for oral healthcare or you are unwilling to agree to our Payment for Services terms.
  • You are unwilling to agree to our General Informed Consent terms.
  • You are unwilling or unable follow our recommended treatment plan or clinic procedures.

We reserve the right to discontinue or dismiss you as a patient if:

  • You have failed to appear to three scheduled appointments over a 12-month period with less than 24 hours’ notice or no notice at all. Being late 15 minutes or more is considered a failed appointment.
  • You exhibit unsafe or disruptive behavior that interferes with the effective delivery of care to you or other patients, or with the learning environment within TUSDM.
  • You (or responsible third party) fail to pay for treatment.
  • Your conduct otherwise results in an irreparable breakdown of the dentist-patient relationship.

The decision to dismiss a patient, i.e., terminate the provider-patient relationship, is a serious matter and is made only after careful review. We will provide a written 30-day advance notice of a decision to terminate your relationship with TUSDM to give you time to transition your care to another provider.