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Patient Online Consent– Sharing Patient Information With Smilo.ai

Patient Online Consent– Sharing Patient Information With SMILO.AI

LOGO

1. What is Smilo.ai?

The Smilo.ai system uses a smartphone application (used by Patients) and a web platform (used by Dentists) to share information about oral health issues, including images of the teeth and gums, in between dental appointments. Your dental practice subscribes to Smilo.ai.

NOTE: Smilo.ai and your Dentist cannot provide a diagnosis using Smilo.ai alone and using Smilo.ai does not replace the need to visit your Dentist on a regular basis or when issues arise.

2. Why have I been given this Smilo.ai consent form?

It is intended that you and your Dentist will share your personal information and images of your teeth and gums for a virtual consultation and pre-screening through Smilo.ai. We need your consent before your Dentist can share your information through Smilo.ai. You can find out more information about how Smilo.ai uses your personal information by viewing the Smilo.ai Privacy Policy at the following link: https://www.smilo.ai/privacy_policy.

3. Giving your consent

a) By selecting the tick box below, I consent to my Dentist uploading my information and images to Smilo.ai. I acknowledge that once uploaded to Smilo.ai, my personal information will be accessible by Oral Tech AI Pty Ltd, which owns and manages Smilo.ai, but only as set out in the Smilo.ai Privacy Policy (see https://www.smilo.ai/privacy_policy).

b) I understand that Smilo.ai does not and cannot provide a diagnosis and is only used for pre-screening and that I must regularly visit my Dentist for assessment and treatment.

c) I acknowledge that I have had the time necessary to read and understand the Smilo.ai Privacy Policy and this consent form.

d) I understand that I can withdraw my consent at any time and that this will not in any way limit the services provided by my Dentist.