1. Payments: Payment for service is expected at the end of each visit. Certain circumstances require special consideration.
Please discuss these with your dentist.
2. Appointments: In order to treat you effectively, we will reserve an appointment time solely for you. We require your co-operation
in keeping these appointments. If you cannot keep your appointment time, we require 48 hours notice. Otherwise, a fee will be
Consent for Treatment
This is to certify that I, the undersigned, have read the foregoing and consent to the performing of the dental procedures agreed to be
necessary or advisable. I will assume responsibility for fees associated with those procedures.