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Terms and conditions

In consideration of receiving treatment by the University of Manitoba’s Dr. Gerald Niznick College of Dentistry ("College"), I acknowledge and agree as follows:

1. The College’s main purpose is to train and educate learners of dentistry and dental hygiene.  I consent to treatment by such learners, under the supervision of a licensed dentist and/or registered dental hygienist.
2. Treatment at the College will be slower than in a private dental practice, especially during the summer months.
3. I accept the risks associated with participating as a patient of the College, including the fact that treatment is provided by College learners and may not proceed in a timely manner.
4. The College relies on information I provide for determining my oral health care treatment, including information I provide about my dental history and medical history.
5. I will comply with all oral health and oral hygiene recommendations and treatment instructions provided by the College.
6. I confirm there is no guarantee that any treatment provided to me by the College will be curative and/or successful.
7. I understand there is a risk of failure, relapse or worsening of my present dental condition after treatment by the College.
8. I release the University, the College, its learners, staff and representatives from any and all claims for injuries, damages or expenses I may suffer due to my participation as a patient of the College.  This release also applies to anyone making such claims on my behalf. This release shall continue in effect even after I am no longer a College patient.
9. I will pay all fees due to the College on the date I receive treatment.  
10. I will cooperate with the College’s learners and staff to ensure a safe and secure environment. I will comply with all College requirements intended to ensure a safe and secure environment including all policies regarding needle stick injuries and blood borne pathogens.  I understand my failure to act in an appropriate manner may result in my dismissal as a patient of the College.
11. The College may, without cause, provide me with notice of termination of services/dismissal as a patient, with seven days’ notice, either verbally or in writing.
12. The College will use my personal information, e.g., charts, molds, photographs and radiographs (x-rays) for treatment, teaching and research purposes.  Telephone conversations may be recorded for quality assurance and teaching purposes and to seek out consultations from my treating physicians for the purposes of dental treatment. Telephone conversations may be recorded for quality assurance and teaching purposes.
13. The College uses an electronic appointment reminder system (via email, text or telephone). I will keep my contact information on file with the College up to date.

Notice Regarding Collection, Use, and Disclosure of Personal Health Information by the University

Your personal health information is being collected under the authority of The University of Manitoba Act. The information you provide will be used by the University for the purpose of setting up your patient record with the Dr. Gerald Niznick College of Dentistry and booking your initial screening. Your personal health information may be disclosed to insurance companies for billing purposes. Your personal health information will not be used or disclosed for other purposes, unless permitted by The Personal Health Information Act (PHIA). If you have any questions about the collection of your personal health information, contact the Access & Privacy Office (tel. 204-474-9462), 233 Elizabeth Dafoe Library, University of Manitoba, Winnipeg, MB, R3T 2N2.