I declare that the above information is correct. I also understand that this practice has no agreement with any medical aid scheme for direct invoicing and take responsibility for settlement of the account. Please note, Dental Cone Beam Scan will not be covered by your Medical Aid. This practice has a 24 hour cancellation policy and I understand I will be held accountable for a cancellation fee if an appointment was missed or canceled on the day.

The undersigned signatory to this schedule binds himself/herself as surety and co-principal debtor for the punctual payment, by the patient and/or the person responsible for the account, of all amounts due to Dr Johann Lochner and Dr Retief Wessels. In the event that it becomes necessary to institute legal proceedings to enforce payment of any amount due to Dr Johann Lochner and Dr Retief Wessels, the party liable therefore shall pay all the fees and disbursements in connection therewith on the scale between attorney and own client. The signatory chooses his / her home address given as above as the domicilium et executandi address.

Introduction DR JOHANN LOCHNER & DR RETIEF WESSELS are committed to respecting your privacy and committed to protecting your personal data as required in terms of the Protection of Personal Information Act 4 of 2013.

We submit that the information obtained from you by our office is necessary in order for us to render a service to you. We will hold and use personal information about you for the following purposes: •To fulfill our obligations to you when providing you with Dental care.
•To share your information with others where necessary to fulfill our obligation to you when providing you with Dental care, eg referring you to another
Dental or Medical Practitioner or Dental or Medical laboratory.
•To communicate with you during the course of providing our services, for example with your enquiries and requests, Medical Aid claims and billing purposes;
•To remind you of follow-up appointments needed. When necessary, the processing and the sharing thereof with a third party such as debt collectors in accordance with our legitimate interest.

How long do we keep your data for? Whilst there are no legal requirements in the sense of legislation or case law dealing with the period of time that a practitioner needs to keep clinical records, there are ethical guidelines, published by the Health Professions Council of South Africa, which state that records should be stored for a period of not less than six years as from the date that they become dormant, so far as it is practically and financially possible to do so.

Is your data secure? We are committed to ensuring that your information is secure. Your data is held on a secure server with necessary technological measures put in place to safeguard it from unauthorized access. All information collected via our website is stored and encrypted on our secure server. The data that we collect from you may be stored and processed by our staff and clinicians. We have taken all the necessary steps to ensure that your data is treated by them securely and in accordance with this policy.

Complaints about the use of your personal data. If you wish to raise a complaint on how we have handled your personal data, you can contact Dr Alet Lochner, our Deputy Information Officer, at alet@johannlochner.com

I declare that the above information is correct.