I wish to register as a patient with a dentist at Cygnet House Dental Studio & Implant Centre
I understand and agree the following
• That the agreement by which I will be given dental treatment is an arrangement between the dentist and myself.
• That, under my treatment plan, my treatment will have to be paid for in total by the last visit.
• That, under my treatment plan; I may be required to pay in advance for certain items of treatment.
• That, under my treatment plan, there will be a charged fee for an appointment missed or cancelled without 48 hours prior notice as per the cancellation policy.