NO SHOW AND CANCELLATION POLICY

Please make certain to fill out all five forms before you come for your first visit so that we can spend your entire first visit diagnosing your dental condition and mutually establish the trusting, caring relationship we value having with all our patients.

  1. Medical History Form
  2. Patient Account Information
  3. Corah's Dental Anxiety Scale
  4. Mount Sinai Dental Fear Inventory
  5. No Show & Cancellation Policy

NO SHOW AND CANCELLATION POLICY

Please be advised that we require at least 48 hours or two business days notice whenever an appointment needs to be changed. One of the reasons that we consistently run on time in our office versus most doctor’s offices is that we do NOT double book or over book our schedule. This allows us to give you the personalized high quality attention that you deserve. To cancel an appointment without proper notice prevents us from being able to offer this time to other patients. In addition, minimizing schedule changes also allows us to not have to raise our fees.

You will be billed for NO SHOW appointments / appointments cancelled less than two business days ahead ($125 for a hygiene visit and $200/hr. for doctor visits).
In the event that you realize that you won’t be able to keep an appointment over a weekend, please call the office and our voicemail will give you the doctor’s pager number to alert us. This way if we receive any emergency calls, we will know how to accommodate these patients, the same way that you would want to be accommodated if you had an emergency.

We thank you in advance for your cooperation. Please acknowledge this policy by filling in your name below and submitting, which will be accepted in lieu of your actual signature.

Name *
Name