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  • *A new policy has been in effect as of 2014. All patients must give 24 hours notice of cancellation for an appointment. If the 24-hour notice was not met or a patient fails his or her appointment there will be a $75.00 charge for Hygiene Appointment and $150.00 for Restorative Appointment to his or her account.

  • HIPPA Acknowledgement Of Receipt Of Notice Of Privacy Practice

  • Have read/received a copy of this office’s Notice of Privacy Practices.
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  • For Office Use Only

    We attempted to obtain written acknowledgement of receipt of our Notice of Privacy Practices, but acknowledgement could not be obtained because: