Deposit, Cancellation and Non attendance First Name Last Name Date of Birth Your email address Physical Address Post Code By signing this form, I agree that the practice policy of deposit taking, appointment cancellation and non-attendance has been explained to me in full. I agree that I have had the opportunity to ask questions and have had all questions and queries answered fully to my complete satisfaction. Our staff at the Enamour Dental Clinic are committed to providing the highest quality of dental care and services to our patients. Dental procedures require planning and preparation; this includes appropriate staffing, treatment room availability and material preparation at specific times during our work day. We reserve specific time blocks (sometimes in excess of 4 hours) in an attempt to meet patient schedules and the urgency of the dental need. If you have made an appointment with us, that time has been reserved exclusively for you and we have prepared in advance for your visit. Failure to attend or give appropriate notice of cancellation severely affects our business and running costs and is unfair to all of our staff that have worked hard to prepare for your visit, and unfair to other patients to could have booked an appointment in this time. Sometimes due to exceptional circumstances, patients need to cancel late and we will take this into account. Deposits The Enamour Dental Clinic holds the right to ask for a deposit prior to booking any dental appointments. The deposit may range from £25 to the entire cost of the treatment (sometimes in excess of £1000). These deposits are taken off the price of treatment on the day, assuming the patient attends. Should the patient fail to give appropriate notice or fail to attend, we hold the right to keep the deposit. Cancellation If you are unable to attend your appointment for any reason, then you should tell us as soon as possible and no later than 48 hours before the scheduled start time for appointment. Failure to give appropriate notice will result in loss of the deposit, regardless of the amount. Non-attendance (including late cancellation) If you miss appointments repeatedly and waste clinical time, we hold the right to ask for payment in full for appointments and/or treatment prior to the appointment. We also hold the right not to book any future appointments for you. Appointment reminders You should not rely on our text message or email reminders solely. We will not take any responsibility for missed appointments or late cancellations as a result of non-delivery or late-delivery of text or email reminders. Parking We do not provide parking and we are not responsible for payment of parking or parking fines. We do not accept responsibility for patients finding parking, parking tickets or parking fines. Practice cancellation/delay Sometimes due to unforeseen circumstances, such as emergencies or sudden illness, the practice may be required to cancel your appointment with little notice, or your appointment may be delayed. Though we try to avoid this as much as possible, given the nature of dentistry, it is sometimes beyond our control. We do not offer refunds or discounts if we cancel an appointment or run late. By signing this form, I agree to pay deposits prior to dental appointments, and agree that if I fail to attend or give sufficient notice prior to cancellation for any reason, I will lose my deposit. enamourdente.co.uk 206 High Street Sutton, SM1 1NU (020) 8642 1945 Signed by I have read, understood and agree to the terms laid out in this form I Agree Send New Weekly offers Advanced £100 £ 90 00 Airflow Manual hand scale & polish 45 minutes Pro-Max Our Most Popular Option £150 £ 120 00 Ultrasonic Scale & Polish Airflow 1 hour Popular Pro £120 £ 100 00 Ultrasonic Scale & Polish 45 minutes