No Results Found

The page you requested could not be found. Try refining your search, or use the navigation above to locate the post.

Book An Appointment

"*" indicates required fields

Patient Name*
Address*
Patient Status*
I am a/an*
Preferred time*

ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES

*You may refuse to sign this acknowledgement*

"*" indicates required fields

Date of Acknowledgement*
This field is for validation purposes and should be left unchanged.

Notice of Information/Privacy Practices

cancel

This "Notice of Information/Privacy Practices" is used to inform website visitors regarding our policies with the collection, use, and disclosure of Personal Information if anyone decided to use our Service.

If you choose to use our Service, then you agree to the collection and use of information in relation with this policy. The Personal Information that we collect are used for providing and improving the Service. We will not use or share your information with anyone except as described in this Privacy Policy.

Information Collection and Use

For a better experience while using our Service, we may require you to provide us with certain personally identifiable information, including but not limited to your name, phone number, and postal address. The information that we collect will be used to contact or identify you.

Log Data

We want to inform you that whenever you visit our Service, we collect information that your browser sends to us that is called Log Data. This Log Data may include information such as your computer’s Internet Protocol ("IP") address, browser version, pages of our Service that you visit, the time and date of your visit, the time spent on those pages, and other statistics.

Cookies

Cookies are files with small amount of data that is commonly used an anonymous unique identifier. These are sent to your browser from the website that you visit and are stored on your computer’s hard drive.

Our website uses these "cookies" to collection information and to improve our Service. You have the option to either accept or refuse these cookies, and know when a cookie is being sent to your computer. If you choose to refuse our cookies, you may not be able to use some portions of our Service.

Service Providers

We may employ third-party companies and individuals due to the following reasons:
  • To facilitate our Service;
  • To provide the Service on our behalf;
  • To perform Service-related services; or
  • To assist us in analyzing how our Service is used.
  • We want to inform our Service users that these third parties have access to your Personal Information. The reason is to perform the tasks assigned to them on our behalf. However, they are obligated not to disclose or use the information for any other purpose.

    Security

    We value your trust in providing us your Personal Information, thus we are striving to use commercially acceptable means of protecting it. But remember that no method of transmission over the internet, or method of electronic storage is 100% secure and reliable, and we cannot guarantee its absolute security.

    Links to Other Sites

    Our Service may contain links to other sites. If you click on a third-party link, you will be directed to that site. Note that these external sites are not operated by us. Therefore, we strongly advise you to review the Privacy Policy of these websites. We have no control over, and assume no responsibility for the content, privacy policies, or practices of any third-party sites or services.

    Changes to This Privacy Policy

    We may update our Privacy Policy from time to time. Thus, we advise you to review this page periodically for any changes. We will notify you of any changes by posting the new Privacy Policy on this page. These changes are effective immediately, after they are posted on this page.

I agree to the HIPAA Privacy Statement
To sign left click and drag mouse or use your finger or stylus if touch screen RESET
lock SUBMIT
HIPAA COMPLIANT FORM

Appointment Cancellation Policy

"*" indicates required fields

We strive to provide the highest level of dental care to each of our patients. When an appointment is scheduled for you, we set aside a certain amount of time for our team to complete your dental treatment.

We will make every effort to confirm your appointment with texts, emails and phone calls. When you receive these messages, please respond and confirm your appointment time. If you must cancel your appointment, we ask that you notify us at least 24 hours in advance of your scheduled appointment time. This will enable another patient who is waiting for an appointment to be scheduled in that time slot.

If you miss your appointment or if you cancel with less than 24 hour notice you will be charged a $25 for an appointment with the hygienist and $50 for an appointment with the doctor. The fee may be higher depending on the amount of time set aside for your appointment. This fee cannot be billed to your insurance company and it must be paid prior to your next appointment. No future appointments can be scheduled, and no records may be transferred until this fee has been paid.

Additionally, if a patient is more than 10 minutes late for an appointment without prior notice, we will consider this a missed appointment and the $25 cancellation fee will be charged.

We understand that emergencies and unforeseen circumstances occur, but we do expect the courtesy of a phone call. We firmly believe that good doctor/patient relationship is based upon mutual respect and communication. We value our patients and appreciate your understanding.

I have read and understand the Appointment Cancellation Policy of the practice and agree to be bound by its terms. I also understand and agree that such terms may be amended from time-to- time by the practice.

Date*
This field is for validation purposes and should be left unchanged.

Notice of Information/Privacy Practices

cancel

This "Notice of Information/Privacy Practices" is used to inform website visitors regarding our policies with the collection, use, and disclosure of Personal Information if anyone decided to use our Service.

If you choose to use our Service, then you agree to the collection and use of information in relation with this policy. The Personal Information that we collect are used for providing and improving the Service. We will not use or share your information with anyone except as described in this Privacy Policy.

Information Collection and Use

For a better experience while using our Service, we may require you to provide us with certain personally identifiable information, including but not limited to your name, phone number, and postal address. The information that we collect will be used to contact or identify you.

Log Data

We want to inform you that whenever you visit our Service, we collect information that your browser sends to us that is called Log Data. This Log Data may include information such as your computer’s Internet Protocol ("IP") address, browser version, pages of our Service that you visit, the time and date of your visit, the time spent on those pages, and other statistics.

Cookies

Cookies are files with small amount of data that is commonly used an anonymous unique identifier. These are sent to your browser from the website that you visit and are stored on your computer’s hard drive.

Our website uses these "cookies" to collection information and to improve our Service. You have the option to either accept or refuse these cookies, and know when a cookie is being sent to your computer. If you choose to refuse our cookies, you may not be able to use some portions of our Service.

Service Providers

We may employ third-party companies and individuals due to the following reasons:
  • To facilitate our Service;
  • To provide the Service on our behalf;
  • To perform Service-related services; or
  • To assist us in analyzing how our Service is used.
  • We want to inform our Service users that these third parties have access to your Personal Information. The reason is to perform the tasks assigned to them on our behalf. However, they are obligated not to disclose or use the information for any other purpose.

    Security

    We value your trust in providing us your Personal Information, thus we are striving to use commercially acceptable means of protecting it. But remember that no method of transmission over the internet, or method of electronic storage is 100% secure and reliable, and we cannot guarantee its absolute security.

    Links to Other Sites

    Our Service may contain links to other sites. If you click on a third-party link, you will be directed to that site. Note that these external sites are not operated by us. Therefore, we strongly advise you to review the Privacy Policy of these websites. We have no control over, and assume no responsibility for the content, privacy policies, or practices of any third-party sites or services.

    Changes to This Privacy Policy

    We may update our Privacy Policy from time to time. Thus, we advise you to review this page periodically for any changes. We will notify you of any changes by posting the new Privacy Policy on this page. These changes are effective immediately, after they are posted on this page.

I agree to the HIPAA Privacy Statement
To sign left click and drag mouse or use your finger or stylus if touch screen RESET
lock SUBMIT
HIPAA COMPLIANT FORM

PATIENT RECORD TRANSFER REQUEST

"*" indicates required fields

MM slash DD slash YYYY
Date*

Please forward current bitewings, fmx or pan that you may have to our office at the below address or, if digital, email to Info@ChrisSiachosDMD.com. We appreciate your prompt attention to this request!

Chris N. Siachos, DMD 1352 Cleveland Street Greenville, SC 29607 Ph: 864-271-9582 Fax: 864-509-0157
Please list the name(s) if you are requesting x-rays for family member(s) under the age of 18. Include name and date of birth.
This field is for validation purposes and should be left unchanged.

Notice of Information/Privacy Practices

cancel

This "Notice of Information/Privacy Practices" is used to inform website visitors regarding our policies with the collection, use, and disclosure of Personal Information if anyone decided to use our Service.

If you choose to use our Service, then you agree to the collection and use of information in relation with this policy. The Personal Information that we collect are used for providing and improving the Service. We will not use or share your information with anyone except as described in this Privacy Policy.

Information Collection and Use

For a better experience while using our Service, we may require you to provide us with certain personally identifiable information, including but not limited to your name, phone number, and postal address. The information that we collect will be used to contact or identify you.

Log Data

We want to inform you that whenever you visit our Service, we collect information that your browser sends to us that is called Log Data. This Log Data may include information such as your computer’s Internet Protocol ("IP") address, browser version, pages of our Service that you visit, the time and date of your visit, the time spent on those pages, and other statistics.

Cookies

Cookies are files with small amount of data that is commonly used an anonymous unique identifier. These are sent to your browser from the website that you visit and are stored on your computer’s hard drive.

Our website uses these "cookies" to collection information and to improve our Service. You have the option to either accept or refuse these cookies, and know when a cookie is being sent to your computer. If you choose to refuse our cookies, you may not be able to use some portions of our Service.

Service Providers

We may employ third-party companies and individuals due to the following reasons:
  • To facilitate our Service;
  • To provide the Service on our behalf;
  • To perform Service-related services; or
  • To assist us in analyzing how our Service is used.
  • We want to inform our Service users that these third parties have access to your Personal Information. The reason is to perform the tasks assigned to them on our behalf. However, they are obligated not to disclose or use the information for any other purpose.

    Security

    We value your trust in providing us your Personal Information, thus we are striving to use commercially acceptable means of protecting it. But remember that no method of transmission over the internet, or method of electronic storage is 100% secure and reliable, and we cannot guarantee its absolute security.

    Links to Other Sites

    Our Service may contain links to other sites. If you click on a third-party link, you will be directed to that site. Note that these external sites are not operated by us. Therefore, we strongly advise you to review the Privacy Policy of these websites. We have no control over, and assume no responsibility for the content, privacy policies, or practices of any third-party sites or services.

    Changes to This Privacy Policy

    We may update our Privacy Policy from time to time. Thus, we advise you to review this page periodically for any changes. We will notify you of any changes by posting the new Privacy Policy on this page. These changes are effective immediately, after they are posted on this page.

I agree to the HIPAA Privacy Statement
To sign left click and drag mouse or use your finger or stylus if touch screen RESET
lock SUBMIT
HIPAA COMPLIANT FORM