Lawrence Dental Solutions

Cancellation and Punctuality Policy

*Patient Name:

Last name

Mid name

First name

In order to best meet each of our client’s needs, our office has enacted the following cancellation and punctuality policy:

-	To cancel without charge, it is your obligation to provide at least forty eight (48) BUSINESS hours notice. You will be charged $200 for each hour of your scheduled appointment time should you fail to attend your appointment, or fail to provide adequate notice of cancellation or rescheduling.
-	If you arrive late for your appointment, your treatment will be modified. All appointments end on time so that the next client will not be inconvenienced. Late arrival will not result in an extended appointment time.

By signing below, you acknowledge that you understand the cancellation and punctuality policies outlined above.

*Signature:		Date:
(Your digital signature (full name) is as legally binding as a physical signature.)