PATIENT RESPONSIBILITIES GUIDELINES
1. Get my own ride to each dental appointment.
2. Arrive on time or early (15 minutes before scheduled time)
3. Be kind, thankful, respectful and cooperative at all times with D-DENT staff, as well as the volunteer dentists and their staff.
4. I understand and agree that if at any time during my waiting period or during my treatment, I behave inappropriately, discourteous or uncooperative, act or talk rude to D-DENT staff and/or volunteer dentists and their staff, I will be disqualified to receive dental care. This means that I will be removed from the D-DENT program and I will not be eligible to receive and/or continue dental treatment through D-DENT.
5. I understand that ONE (1) NO SHOW appointment MAY disqualify me from receiving dental care through D-DENT.
6. I understand and agree that all appointments must be made by D-DENT staff and that I am responsible for calling D-DENT after each dental appointment to report appointment information.
7. I agree to NOT cancel or change any dental appointments unless I have called and received permission from D-DENT staff.
8. I understand that D-DENT is a one-time pass through program. After the volunteer dental professionals have finished their treatment, my case
will be considered COMPLETED and I will not be eligible for future dental treatment through D-DENT.
9. I understand and agree to follow directions of the dentists and staff to preserve and do my best to maintain my dental health, including the practice of regular dental hygiene procedures and care of prosthetic appliances as indicated.
10. I understand and agree that I can be dropped from the D-DENT program at any time if I do not follow the rules of this contract.
11. I understand that if I'm eligible, I will be placed on a WAITING LIST. The waiting period varies per case. It can be anywhere between one (1) month to five (SJ years depending on the need, the area of residency, volunteers, and funding availability.