Privacy Practices Form

DO NOT USE THIS FORM if you are a MEDENT CLIENT or working on behalf of one. Please submit a form via the Support link on the previous page or call 315-255-0900.

Please fill out the following form to report a privacy concern or issue. Note: This form is not to be used to submit support requests, or requests on behalf of clients. All solicitations will be closed.

Name (optional):

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Issue/Concern: (required)