Patient No Call/ No Show Agreement

    Effective September 1st, 2023 Sapphire Family Dental will enforce a No Call & No Show Agreement. It is necessary for us to make appointments to see our patients as efficiently as possible. Missed appointments take away an available time slot from another patient waiting to be seen.

    It is your responsibility to keep a record of your appointment and to arrive on time. If you need to cancel or reschedule your appointment, please try to call 24 hours in advance.

    Every No-Show visit will be recorded in your chart. Multiple No-Show appointments within a 12 month period can result in dismissal of dental care at Sapphire Family Dental.

    We understand that a personal emergency may occur, and you may not be able to notify us in advance. These situations will be considered on a case by case basis.

    After One (1) No Show: You will receive a letter and a phone call informing you of the No Show with a copy of this policy /agreement. You will be able to continue to receive care at Sapphire Family Dental.

    After Two (2) No Shows: You will receive a second letter and phone call reminding you that this is your 2nd No Show. This will result in a $100 No Show Fee. This will be the final notice of our No Show Policy
    After Three (3) No Shows: You will receive another letter informing you that this is your 3rd No show resulting in a $125 fee and possible dismissal as a patient.

    Acknowledgement of the No Call/No Show Agreement

    (After you click Submit, please make sure you complete both forms)