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APPOINTMENT and FINANCIAL POLICY AGREEMENT

Our goal is to provide quality dental care in a timely manner. To do so, we ask that patients adhere to our cancellation and no-show policy. The policy enables us to better utilize available appointments for our patients in need of dental care.

CANCELLATION OF AN APPOINTMENT

To be respectful of other patients’ needs, please call our office promptly if you are unable to attend an appointment. This time will be given to someone who is in urgent need of treatment. We ask that you contact our office two business days (48 hours) in advance to cancel or reschedule your appointment.

NO SHOW POLICY

A ‘no show’ is an appointment that was not canceled in advance (48 hours). No shows inconvenience other patients who need dental care. A ‘no show’ for a scheduled appointment will result in a fee of $100

LATE ARRIVALS

To serve our patients in a timely manner, we ask that you are on time for your scheduled appointment. In the event you are running late, please call the office. If you are more than 15 minutes late to your scheduled appointment, you may be asked to reschedule.

PAYMENT POLICY

We collect your estimated copayment in full at the time of service.

For your convenience, we accept the following methods of payment: Cash, Personal Checks, Visa, MC, AMEX, Discover or CareCredit.

Thank you for choosing OB1 Dental for your dental needs. We look forward to a long-lasting relationship with you.

ACKNOWLEDGEMENT

My signature below indicates that I have read, understand, and agree to the appointment policy above.

All parties involved agree that this document may be signed electronically. The electronic signatures appearing on this document are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility.
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We appreciate you taking the time to complete this form. We'll review the information submitted and be in touch with you if anything additional is required.

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