New Patient Pre-authorization

By reserving an appointment, you are specifically blocking out time in our provider’s schedule.  If you need to change your appointment we request you do so with enough notice to allow other patients access to that provider’s time.  We do this to reduce long wait times for appointments which allow us to treat our patients in a timely manner.  To reserve an appointment, we collect credit card information and save it into our secured merchant system. The card will only be charged our $80 fee if:

1. You do not show up for your appointment

2. You cancel OR change the appointment less than 48 hours prior to the appointment (NOTE: exceptions are always considered for rare unforeseen circumstances)

3. You do not provide dental insurance information in a timely manner and we are unable to verify your benefits. A cancellation due to lack of benefits will still be considered a late cancellation. As such, please ensure we have the dental insurance information needed to verify your insurance as soon as you have scheduled to avoid a late cancellation fee.