Because your health and your oral care is important to us, it is essential that you are aware of the importance of respecting your commitment and being one time for your appointment.
A time slot in our schedule has been reserved for you in order to do the treatment that was planned. Our professional staff work hard for you and in your best interest. Your chart is read thoroughly and carefuly and your treatments are planned with care. An operatory room is also prepared specialy for you and in time for your appointment.
It is therefore a priority to confirm your presence 48 hours prior to your appointment either by phone call, email or voicemail.
By not confirming your presence, we, the Mathew Dental Clinic reserve the right to offer your time slot to someone else.
No shows or same day cancellations will be charged to you a fee of 50$ and therefore noted in your file.
Keep in mind, the Mathew Dental Clinic reserve the right to: after 3 missed appointments or same day cancellations will result in permanently closing your file without notice.
Private insurance
Your responsibility is to know your insurance policy regarding what you can or can’t claim. As well as the terms and conditions and the cleaning frequency allowed by your insurance.
I hereby declare I have read and received all the information regarding Mathew dental clinic’s policy and I accept it. I also was given answers to all my question concerning this document.
Signature
Date:
Signature of the professional: _____________________________ Date: ________________
