Office Policies
This form outlines our appointment and office policies, including scheduling, cancellations, fees, texting/emailing consent and treatment adjustments. Please review the information below carefully, as it explains your responsibilities as a patient and what to expect from our office.
Our goal is to provide high quality care to our patients and respect their schedule as well. In fairness to other patients, and the office staff, we require advanced notice when changing or cancelling an appointment.
When you schedule an appointment, we reserve that time and prepare in anticipation of serving you. If you need to reschedule, we kindly request that you contact us with advanced notice (minimally 48 hours).
Failure to provide at least 48 hours’ notice for a missed or cancelled appointment may result in a missed appointment fee ranging from $40 up to $200, depending on the service scheduled and appointment length. This fee is not billable to insurance and is the patient’s responsibility. The cancellation fee has to be paid prior to rescheduling the missed appointment.
Patients arriving more than 10 minutes late may need to be rescheduled at the discretion of the clinic.
Patients are responsible for providing accurate and current insurance information prior to their appointment. Insurance eligibility and benefits are verified as courtesy and are subject to change at any time. Patients are responsible for all charges not covered by insurance.
Patients who continue to no-show and/or cancel without notice may be dismissed from the practice and asked to find another dentist. Accounts that remain unpaid may be referred to by a third-party collection agency.
Accounts that remain unpaid may be referred to by a third-party collection agency. Once an account has been sent to collections, all non-emergency future appointments may be cancelled, and the patient may not be rescheduled until the account is brought up current. If account is sent to collections and the patient calls to try to schedule an appointment, the collection amount and whatever fees occurred must be paid before the front receptionist can schedule the appointment.
Any patient who is late may be considered a “no show” for their appointment and may need to be rescheduled.
Patients who decline recommended treatment acknowledge that doing so may impact oral health outcomes, and the clinic is not responsible for complications arising from refused or delayed care.
As with any dental treatment, there may be unforeseen treatment adjustments and/or complications. The clinic will try to anticipate any changes in the treatment plan and advise me at that time. However, such events are unpredictable. Likewise, the timing or spacing of appointments may need to be modified as needed to accomplish the best result possible.
By signing below, I consent to receive appointment reminders, account notifications, and other communications from the clinic via phone, text message, voicemail, and email. I understand that all forms must be completed prior to the appointment date and time. If unable to, I understand that I must come in 20 minutes prior to filling it out in office. If I chose to come in at my exact appointment time without forms completed, I understand that some and or all treatment might be rescheduled to a different day.