Teledentistry Consent Form
Your Smile Partners PLLC
99 Wall St, New York, NY 10005
Email: talk@yoursmilepartners.com
Thank you for choosing Your Smile Partners PLLC for your teledentistry needs. If you have questions, contact us at talk@yoursmilepartners.com.
Revised Instructions for Filling the HIPAA Secure Form
Follow these quick, secure steps. We’ve used light background highlights to keep each instruction easy to read.
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1
Fill out the form completely
Enter all required details carefully. Double-check names, dates, and contact information before proceeding.
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2
Click “Print the form.”
This creates a paper or PDF copy for your records. Most browsers allow “Save as PDF” in the print dialog.
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3
Click “Submit and Upload the form.”
The page will guide you to the secure upload portal after submission.
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4
Finally, click “Upload the form.”
Select the saved file from your device and press Submit. That’s it — simple steps to complete the process!
Tip: If the form is on this same page and labeled #consentForm
, “Go to Form” will jump there. Otherwise, it will let you know.