Office Cancellation

We understand that occasionally illness or emergencies occur and you may not be able to give us as much notice in those instances. Our hope is that you understand that we’ve set aside this time in our schedule for you and we need you to make every effort to schedule your appointments at a time that works best for you.

For your convenience we use a company called Demand Force to help remind you of scheduled appointments through texts or email. Please make sure that we have either your correct cell phone number or email on file so that you may get those reminders.

1. First short notice cancel or fail, a $25.00 fee will be charged and will be recorded in your patient record. Verbal reminder of office policy.
2. Second short notice or fail, there will be a charge of $50.00. Verbal reminder of office policy.
3. Third short notice cancel or fail, there will be a $75.00 charge for your missed appointment time and we will only be able to schedule you a same day appointment in the future.

By signing this form, I’m acknowledging that I fully understand Monarch Family Dental’s cancellation policy and accept full responsibility for any fee incurred by me due to a short notice cancellation or failed appointment.