Daniel Castro D.D.S, P.A

6901 Helen of Troy, BLDG. C

El Paso, Texas, 79911

915-581-8070

FAILED APPOINTMENT POLICY

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IT IS OUR OFFICE POLICY THAT A 48 HOUR CANCELLATION NOTICE BE GIVEN FOR ANY DENTAL APPOINTMENT TIIAT A PATIENT IS UNABLE TO KEEP. WE RESERVE TIME, SPECIAL, FOR EACH PATIENT. IF YOU FAlL AN APPOINTMENT OR ARE ROUTINELY LATE YOU MAY BE DISMISSED FROM OUR DENTAL PRACTICE. AN APPOINTMENT IS CONSIDERED FAILED WHEN WE DO NOT RECEIVE A 48-HOUR NOTICE AND THERE IS A $25 CHARGE WHEN RESCHEDULING OR CANCELLING YOUR APPOINTMENT.

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ACKNOWLEDGEMENT OF NOTICE OF PRIVACY PRACTICES

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For Our Office Use Only

Our office attempted to obtain written acknowledgement of receipt of our Notice of Privacy Practices, but acknowledgement could not be obtained for the following reason: