3.4
5 Ratings with 4 written Reviews
Summary
Ormond Beach Dental Group
Dr. Paul Szott, DMD
Dr. Arif Zaman, DMD
802 Sterhaus Dr. Ste. A
Ormond Beach, Fl 32174
(386) 868-4483
HIPAA CONSENT FORM
I understand that, under the Health Insurance Portability & Accountability Act of 1996 (HIPAA), I have certain rights to privacy regarding my protected health information. I understand that this information can and will be used to :
Conduct, plan, and direct my treatment and follow-up among the multiple healthcare providers who may be involved in that treatment directly and indirectly.
Obtain payment from third-party payers (eg. insurance company).
Conduct normal healthcare operations such as quality assessments and physician certifications.
I have been informed by you of your Notice of Privacy Practices containing a more complete description of the uses and disclosures of my health information. I have been given the right to reivew such Notice of Privacy Practices prior to signing this consent. I understand that this organization has the …right to change its Notice of Privacy Practices from time to time and that I may contact this organization at any time at the address above to obtain a current copy of the Notice of Privacy Practices.
I understand that I may request in writing that you restrict how my private information is used or disclosed to carry out treatment, payment, or healthcare operations. I also understand you are not required to agree to my requested restrictions, but if you do agree then you are bound to abide by such restrictions.
I understand that I may revoke this consent in writing at any time, except to the extent that you have taken action relying on this consent.
Patient name:____________________________________________________
Signature: __________________________________Date ________________
Read More Read less Dr. Paul Szott, DMD
Dr. Arif Zaman, DMD
802 Sterhaus Dr. Ste. A
Ormond Beach, Fl 32174
(386) 868-4483
HIPAA CONSENT FORM
I understand that, under the Health Insurance Portability & Accountability Act of 1996 (HIPAA), I have certain rights to privacy regarding my protected health information. I understand that this information can and will be used to :
Conduct, plan, and direct my treatment and follow-up among the multiple healthcare providers who may be involved in that treatment directly and indirectly.
Obtain payment from third-party payers (eg. insurance company).
Conduct normal healthcare operations such as quality assessments and physician certifications.
I have been informed by you of your Notice of Privacy Practices containing a more complete description of the uses and disclosures of my health information. I have been given the right to reivew such Notice of Privacy Practices prior to signing this consent. I understand that this organization has the …right to change its Notice of Privacy Practices from time to time and that I may contact this organization at any time at the address above to obtain a current copy of the Notice of Privacy Practices.
I understand that I may request in writing that you restrict how my private information is used or disclosed to carry out treatment, payment, or healthcare operations. I also understand you are not required to agree to my requested restrictions, but if you do agree then you are bound to abide by such restrictions.
I understand that I may revoke this consent in writing at any time, except to the extent that you have taken action relying on this consent.
Patient name:____________________________________________________
Signature: __________________________________Date ________________
Quick Facts
- 1 insurance plan accepted
- 4 written reviews
- 1 specialty
- 8 areas of expertise
- 1 office location
- Male
Office Location
Compare with Similar Doctors
 |  |  |  |
| Dr. Arif Zaman | Dr Harvey Lester, DMD | Dr Kyle Pettersen, DDS | Dr James Kiser, DDS |
| Dentistry | Dentistry | Dentistry | Dentistry |
| Accepts New Patients | Accepts New Patients | Accepts New Patients | |
| 57 Years of Experience | 16 Years of Experience | 29 Years of Experience | |
| No Virtual Visit Option | Virtual Visit Available | Virtual Visit Available | Virtual Visit Available |
| Speaks Spanish, English | Speaks Spanish, English | Speaks Spanish, English | |
| Orlando , FL | Phoenix , AZ | Jeffersonville , VT | Baton Rouge , LA |
| Med School: University of Pennsylvania | Med School: UCLA | Med School: LOUISIANA STATE UNIVERSITY SCHOOL OF DENTISTRY | |
Current Profile | View Profile | View Profile | View Profile |
Insurance Plans Accepted by Dr. Arif Zaman
Medical Specialties
Dr. Arif Zaman has the following specialty
Specialty Expertise
Dr. Arif Zaman has the following 8 areas of expertise
Certifications, License, & Education
MEDICAL LICENSE
Doctor Of Dental Surgery, Florida, 2026, Expired
Similar Doctors
Frequently Asked Questions
- How can I make an appointment with Dr. Arif Zaman?
- You can find contact information for Dr. Arif Zaman here on Vitals.
- Is Dr. Arif Zaman accepting new patients?
- Dr. Arif Zaman has not indicated that they accept new patients. Contact their office through their Vitals profile to check for availability.
- Does Dr. Arif Zaman accept my insurance?
- You can see the insurance plans that Dr. Arif Zaman accepts on their Vitals profile.
- Where is Dr. Arif Zaman's office located?
- Dr. Arif Zaman's office is located at 1650 Sand Lake Rd Ste 106, Orlando, FL, 32809.
- Does Dr. Arif Zaman accept virtual/telehealth appointments?
- Dr. Arif Zaman has not indicated that they accept virtual/teleheatlh appointments. Contact their office through their Vitals profile to check for availability.
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