Your Rights and Responsibilities

Derechos y Responsabilidades del Paciente [PDF]

Your Rights as a Patient of the School of Dentistry

  1. You have the right to receive treatment that meets or exceeds the current standards of care for the dental profession in a considerate, respectful, and confidential manner regardless of race, gender, age, national origin, religion, sexual orientation, or disability.
  2. You have the right to receive treatment on a regular basis and completed within a reasonable length of time considering the constraints of an academic institution.
  3. You have the right to a copy of information found in your dental record. Please submit Form 09HIP for Adults, or Form 09aHIP for Minors, which can be sent via email to    or via U.S. Postal Service to University of Louisville School of Dentistry, Attention: Records Office, 501 S. Preston St., Louisville, KY  40202
  4. You have the right to be provided with information about the approximate cost of the treatment to be rendered prior to the beginning of treatment and you should understand that the fee for services may change before this treatment is completed.
  5. You have the right to an explanation of recommended treatment, alternate treatment, and your option to refuse treatment so that you are comfortable in signing your informed consent before initiation of treatment. Only treatment which is of an emergency nature or needed for diagnosis and development of a treatment plan will be done prior to that time.
  6. You have the right to be informed of the treatment options and to have the various programs available in our clinics explained to you. You will also be informed of any risk that you may be taking if an existing dental condition is not treated.
  7. You have the right to know which members of the health care team (dental student, dental hygiene student, graduate dentist, and/or faculty member) are directly responsible for your care, including their names and how you may receive assistance in case of a dental emergency.
  8. You have the right to receive information regarding continuation of care after completion of your dental treatment.
  9. You have the right to withdraw consent and to discontinue participation in the treatment or activity at any time.
  10. A Federal privacy law, known as HIPAA, grants you the following rights: the right to request amendments to your patient information in some circumstances; the right to request certain restrictions to the use of your patient information; the right to request an alternate means of communication; the right to request an accounting of those who used your patient information for any means other than for treatment, payment, and/or healthcare operations; the right to receive the school’s Privacy Notice; and the right to complain to the school if you believe your privacy rights have been violated.

Patient Concerns Form

The University of Louisville School of Dentistry strives to provide quality work and service in an environment that promotes respect for all.

Patients have the right to express concerns or complaints with the assurance that the submission of a concern will not compromise the quality of care or future access to care.  In order to address any concerns that you may have, please mail us a completed Patient Concerns Form.

Patient Responsibilities

As a patient of ULSD you are expected to:

  • Be respectful of others. Patients who exhibit inappropriate behavior may be dismissed from the program and not allowed re-admission.
  • Come to all scheduled appointments and arrive on time. Patients who are late (15 minutes past appointment time) may be sent away without treatment.
  • Maintain good oral health habits between visits.
  • Have a parent/guardian present for patients under 18 years of age. Children who accompany adult patients will not be allowed to remain in the treatment cubicle during the appointment period.
  • Turn off and put away cell phones while in the treatment cubicle.

    New No-Show Policy

    Patients may be dismissed from the program for:

    • 2 no shows, late arrivals, and/or cancellations with less than 24 hr. notice within a 3 month period.
    • 3 no shows, late arrivals, and/or cancellations with less than 24 hr. notice within a 1 year period.