Appointment Request

(410) 546-7770

Appointment Policy & Request Form

When you are given an appointment for dental care in our office, you are actually reserving a previously identified amount of time. That time, whether it is 10 minutes or 2 hours, is time that has been set aside for you and only you. When that time is lost because of a late cancellation or failure to show up, that time is lost not only to you but also to other patients who could have used that time for their care. As do other health care offices, we have a policy that requires at least 24 hours notice to cancel or change a scheduled dental appointment.

This policy gives us the time to reschedule another patient for that time period. Further, we reserve the right to assess a failed-appointment charge of $42.00, if you do not show up for your scheduled visit, or you cancel your appointment within the 24 hr time period. If that appointment is a multiple one, or more than 1 hour in length, we reserve the right to increase this fee accordingly. We will make every attempt to call you prior to your appointment to remind you of the date and time.

Please be assured that we value you as a patient and, as such, we fully realize that situations and circumstances arise which are impossible to foresee. The decision to assess a fee will be made on an individual case basis. Due to circumstances (eg. patient emergencies) it may be necessary at times for us to reschedule your appointment. We will do our utmost to offer you the same courtesy.

If you should have any questions regarding this policy or its implementation, please do not hesitate to speak with our office manager, Pat Gray at (410) 546-7770.

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

Please do not use this form to cancel or change an existing appointment.

*Items in bold are required.
Are you a current patient?

Preferred day(s) of the week for an appointment?

Preferred time(s) for an appointment?

Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.

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