| Patient name | ID / record number |
| Treating professional | Date |
We will record a video of your face while you move your jaw, and use the scans of your teeth. That lets us measure how you bite and how your jaw moves, so we can plan your treatment.
The video, the scans, the measurements derived from them and the clinical notes are stored together with your name, your identification and your contact details. They are held in a secure cloud in the United States, operated by Google, and a copy passes through a compute service that processes the images. Your treating professional and the technical team that maintains the tool can see them.
Your treating professional is the controller of your clinical data. Toothprint acts as a processor, handling that data on their behalf and on their instructions.
At any time you can ask what we hold about you, ask us to correct it, update it or delete it, and you can withdraw this authorization. Do it through your treating professional, or write to privacy@toothprint.ai. You may also complain to your data protection authority.
One limit we are required to tell you about: clinical records carry a mandatory minimum retention period, so part of this information cannot be deleted even if you ask.
I authorize the processing of my data for my care. This covers recording the session video, using the scans of my teeth, storing all of it together with my identifying details, and storing it abroad as described above.
This is sensitive data. Answering is voluntary and no one is obliged to authorize the processing of sensitive data.
In addition, and only if I want to: I authorize my video and my scans to be used to train the models that make the tool measure better.
This is separate and optional. Not for advertising, not for sale, and not handed to third parties for their own models.
Before you tick it, there is something you need to know: a model that has already been trained cannot be un-trained. If you change your mind later, your material is deleted and excluded from every future training run, but what a model already learned cannot be taken back out of it.
What we do commit to, in writing: retraining the model without your material within six months, or at the next major version, whichever comes first.
If you leave it blank, nothing happens. Your care is exactly the same and the tool works exactly the same.
Additionally, and only if I want to: I authorize a photograph of my face to be taken and turned into a portrait for my record card.
That photograph is sent to a Google artificial-intelligence service (the Gemini API, in the United States), which returns the stylised portrait. Only the photo goes: not my name, not my scans, not my session video.
What Google keeps on their side is governed by their own terms and not by Toothprint's. That is why this box is separate and is never ticked for you.
If you leave it unticked, nothing happens. The card shows your initials and that is all.
Patient signature
or legal guardian if the patient is a minor
Treating professional signature
Controller: the treating professional signing above.
Processor: Juan Manuel Olarte, trading as Toothprint ·
Carrera 25 # 1 A Sur 45, Oficinas 1163 y 1156, Medellín, Colombia ·
+57 305 306 9616 · privacy@toothprint.ai ·
Full policy at toothprint-legal.web.app/privacy
Keep a signed copy. It is the proof of this authorization, and the law requires the controller to hold it.