New Patient Form

Appointment Policy

In the event that your appointment could not be confirmed 24 hours in advance, we reserve the right to cancel it. This way, another patient may benefit from the slot.

Please notify us 48 hours in advance for any changes. I agree to cover the consultation and treatment fees. If payment is not made within 90 days of the visit, I have been informed that the dental clinic may use a collection service, and additional fees will apply. I, the undersigned, declare that I have read, understood, and answered the above medical-dental questionnaire to the best of my knowledge.

I hereby commit to notifying you of any changes to my health status. I authorize the creation of my dental record, its follow-up, and my enrollment on the dentist’s recall list. I am hereby informed of my right to consult my record, request a correction, and withdraw from the recall list.