Patient Information
PATIENT RESPONSIBILITYPERTINENCEREFERRALREGISTRATION FORMSREQUESTING SOCIAL SECURITY NUMBERCANCELLATION POLICYTARDINESSPAYMENT POLICYINDEPENDENT FINANCINGPREPAYMENT REQUIREMENT FOR DENTAL LAB WORKDENTAL INSURANCEINSURANCE PAYS SUBSCRIBEREMERGENCY APPOINTMENTINITIAL APPOINTMENT (NON-EMERGENCY)TREATMENT PLANAPPOINTMENT ORDERAPPOINTMENT CONFIRMATIONSCHEDULE CHANGESAPPOINTMENTS FOR FAMILIESREFUSAL OF TREATMENTRECORD TRANSFER REQUESTQUESTIONSDISCLAIMERHIPAA NOTICE OF PRIVACY PRACTICESAPPOINTMENT CONFIRMATION
Attending a scheduled appointment is the responsibility of the patient.As a courtesy, this office has an automated reminder system.
Text and /or e-mail appointment reminders are sent one (1) month prior, seven (7) days prior, five (5) days prior
if the seven (7) days prior is not confirmed, one (1) day prior, and one (1) hour prior.
As a courtesy, if the automated system is not utilized or responded to, this office will attempt to confirm by telephone call the business day before.
Regardless of whether or not the appointment is confirmed, the patient is responsible for attending the scheduled appointment.
