Acknowledgement of Receipt of
Notice of Privacy Practices

I have been given a copy of Harry L. Habbel, D.D.S. Notice of Privacy Practices (”Notice”), which describes how my health information is used and shared. I understand that the Practice has the right to change this notice at any time. I may obtain a copy by contacting the Practice Privacy Offier.

My signature below acknowledges that I have been provided with a copy of the Notice of Privacy Practices:

For Facility Use Only: Complete this section if you are unable to obtain a signature

If the patient or personal representative is unable or unwilling to sign this Acknowledgment, or the Acknowledgment is not signed for any other reason, state the reason:

Smile Success Stories

Recent testimonials from our patients

Personable, friendly, and professional.
Normally I hate going to the dentist, as most do. It was my first visit for a consultation...a completely new experience and all. I was quickly put at ease by Dr. Habbel and his staff. Looks like I've found a new dentist for life.
~ Steve M.

My teeth and mouth feel great.
I started coming to Dr. Habbel when I was a kid and now bring my family because of his level of care and work. The staff are always friendly and make you feel like family.

~ S.

All Reviews