We respectfully ask that you give us a minimum of 24 hours notice to cancel or reschedule your appointment. Please help us serve you better by keeping scheduled appointments.
We hope this information has been helpful. As always, feel free to ask any member of our staff for clarification on services, billing and insurance.
I acknowledge that I understand the terms of this form and assume full financial responsibility for all unpaid dental services rendered on my behalf or my dependents, with or without the use of insurance coverage.