Public >> Statement of Patient Rights & Responsibilities

Statement of Patient Rights & Responsibilities

As a patient you have certain rights:

  • 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 and 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 (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 Office of Patient Relations at

If you believe that the Dental School has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with the TUSDM Compliance Office (

As a patient you have certain responsibilities:

  • Provide your complete and accurate health history
  • Ask questions and understand your treatment plan
  • Keep your appointments and be on time
  • Pay for your treatment at the time of service
  • Respect 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 health care or you are unwilling to agree to our Payment for Services terms.
  • You are unwilling to agree to the terms of our General Informed Consent.
  • 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 3 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 the Dental School.
  • 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—terminate the provider-patient relationship—is a serious matter and is made only after careful review. We will provide written 30-day advance notice of a decision to terminate your relationship with the Dental School in order to allow you time to transition your care to an outside provider.