Patient Consent Form

Thank you for your continued trust in our practice. Thank you for trusting your dental care to Ruby Dental Group. When you schedule an appointment with Ruby Dental Group we set aside enough time to provide you with the highest quality of care. Should you need to reschedule an appointment please contact our office as soon as possible and no later than 24 hours prior to your scheduled appointment. This gives us enough time to schedule other patients who may be waiting for an appointment. Please see our Appointment Cancellation / No Show Policy below: Effective October 1, 2022 any established patient who fails to show or cancels/reschedules an appointment and has not contacted our office within at least 24 hours notice will be considered a No Show and charged a $50.00 fee. Any established patient who fails to show or cancels / reschedules an appointment with no 24 hour notice a second time will be charged a $75.00 fee Any new patient who fails to show for their initial visit will not be rescheduled. Fees will be charged to the Patient and not to the Patient's insurance company and are Due at the time of the patient's next office visit. As a courtesy, when time allows, we make reminder calls for appointments. If you do not receive a reminder call or message, the above Policy will remain in effect. We understand there may be times when an unforeseen emergency occurs and you may not be able to keep your scheduled appointment. If you experience extenuating circumstances please contact our office 24 hours a day either by email or by phone. Thank you for your understanding.