We will make every attempt to provide convenient appointment times for you within our normal business hours. We respect your time and will make every effort to begin your dental appointment on time. We will provide you with estimated appointment lengths so you may plan your day appropriately.
Should you need to reschedule an appointment, we ask for at least two working days notice based on our hours of operation. Repeated failure to provide two working days notice will result in a Broken Appointment charge of $100.
**Please note that our office hours of operation are Monday - Thursday and Friday is not considered a working day.**
Patient's First Name: *
Patient's Last Name: *
The person filing out form is: *
If Representative, Representative's Name:
By refusing to sign the above guideline, I am aware that after two missed appointments, without contacting the office two working days prior, I will be dismissed from this office.
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