Patient Information & Practice Agreement Sample Contracts

Patient Information & Practice Agreement
Patient Information & Practice Agreement • August 12th, 2015

We would like to extend a warm welcome to Studio B Smiles the dental office of Dr. John Badolato and Associates. We are a full- service general and cosmetic dental practice. Studio B Smiles offers a wide array of services ranging from basic exams to complete smile makeovers. The doctors and team at Studio B Smiles strive to provide excellent clinical care as well as an unparalleled level of customer service. While we do accept certain insurance plans, we do not allow insurance to dictate treatment. In this office, your best interest is the only interest we will consider. We look forward to providing you with excellent dental care for many years to come.

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PATIENT INFORMATION & PRACTICE AGREEMENT
Patient Information & Practice Agreement • September 17th, 2020

The information I have provided on this form is accurate and complete to the best of my knowledge, information and belief. I will notify the practice at the soonest practical moment of any changes in the information I have provided. In consideration of being accepted as a patient of the practice, I agree to abide by the terms and conditions of this patient application & practice management.

Patient Information & Practice Agreement
Patient Information & Practice Agreement • March 26th, 2015

We would like to extend a warm welcome to our practice, where helping you obtain a healthy, beautiful smile is what we love to do best! Our goal is to help you reach and maintain maximum oral health. We are committed to making sure your visits with us are comfortable and enjoyable. Please fill out this form completely.

Patient Information & Practice Agreement
Patient Information & Practice Agreement • February 15th, 2016

We would like to extend a warm welcome to our practice, where helping you obtain a healthy, beautiful smile is what we love to do best! We are a full-service cosmetic and general dental practice where all procedures are performed with an artistic eye and from an aesthetic point of view. We are committed to making sure your visits with us are comfortable and enjoyable.

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