Notice of Privacy Practices (HIPAA)

Effective Date: January 22, 2026

This Notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.

Our Responsibilities

Cross Timbers Dental is required by law to:

• Maintain the privacy of your protected health information (PHI)

• Provide you with this Notice

• Follow the terms of this Notice

Uses and Disclosures of PHI

We may use and disclose your PHI for:

• Treatment

• Payment

• Healthcare operations

• As required by law

Your Rights

You have the right to:

• Inspect and obtain copies of your health records

• Request corrections to your health information

• Request restrictions on certain uses or disclosures

• Request confidential communications

• Receive a paper copy of this Notice

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our office or with the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.

Contact for HIPAA Matters

Cross Timbers Dental
2240 Cross Timbers Road
Flower Mound, Texas 75028
Phone: 972-355-8500
Email: [email protected]