Appointments | Gordon Dentistry

Gordon Family Dentistry

Patient Appointment Policy

In order to insure optimal quality care, we ask our patients to make their best effort to attend each appointment in a timely manner. We understand that your time is just as valuable as ours. Therefore our dentist/hygienist has reserved a specific time for your appointment to take place and we look forward to seeing you. Patients must arrive 15 minutes prior to their scheduled appointment for you to have enough time to do your updates. We strive to provide the best care possible for our patients and in order to do so we need to work together and be prepared for your visit.

-If patient is 15 minutes late they will be re-appointed and a $50.00 reschedule fee

Patient Communication Form
We are in the process of implementing a new appointment reminder and patient communication system for our practice. Please help us make sure we have the most current information for your account. By providing your contact information below, you are granting permission to be contacted via those communication channels. Your information will only be used to contact you regarding your dental care. Example communications include appointment reminders, reminders to schedule your next appointment and important announcements about our practice.

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Cell Phone*
Email*
When possible I prefer to be contacted via*
- Phone Call
- Text
- Email
Please list any other minors or family members for which this same contact information applies.*
I hereby grant my healthcare provider permission to contact me via and automated phone/text/email system. I authorize my health care provider to disclose to third parties who answer my phone my limited protected health information, and to leave a message on my voicemail system or answering machine.
Signature*
Date*