Cal Dental Group Pasadena

1213 N. Lake Ave, Suite 1 Pasadena, CA 91104

626-584-1800

MISSED APPOINTMENT POLICY

In order to have an efficient and orderly practice, we request your consideration of the dentist's time by asking that you give us 48 hours (we are open every other day) notice if you are unable to keep a scheduled appointment. This allows other patients who are waiting for a cancellation to be notified. We understand that situations sometimes arise that are out of your control and that 24 business hour notice may not be feasible. However, in these situations, we ask that you notify the office as soon as possible. There will be a $60 late cancellation/missed appointment fee. There will always be exceptions. If you arrive late, please let us know as soon as possible. When a patient repeatedly misses scheduled appointments, it becomes an inconvenience to the practice. If you are more than 15 minutes late for your appointment, we may not be able to accommodate you. Therefore, at the discretion of the office, if a patient misses two consecutive appointments without proper notification, they may be dismissed from our clinic. A letter will be sent to the patient informing them of the decision and/or process.I have read the above statement and agree to abide by the policy as stated above.

Name:
Cell:
E-mail address:
Date:
Time:

SIGNATURE

Use your mouse cursor or the tip of your finger to sign below

If signed by someone other than the patient, specify the relationship to the patient.

© 2024 - American Dental Software All rights reserved.