Terms & Conditions
Patient consent under the Data Privacy Act of 2012 (RA 10173)
By accepting, I certify that the information provided in this form is true and correct. I voluntarily give my consent to MyBoss Dental Center to collect, record, use, store, and process my personal and sensitive dental/medical information for the purpose of my medical evaluation, diagnosis, treatment, and hospital billing.
I understand my rights under the Data Privacy Act, including my right to access, correct, or withdraw my consent for my personal data at any time by notifying the clinic.