PATIENT
FORMS
Before your visit, please take a moment to download and fill out any of the following forms that we have requested. The forms can be sent electronically by email OR printed and mailed to the address below.
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NEW PATIENT FORMS:
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Confidential Patient Information
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CANCELLATION POLICY:
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We are dedicated to making every effort to accommodate your scheduling needs. We realize that some situations like illness or emergencies arise and are sometimes unavoidable. However, repeated short notice cancellations are unfair to those patients who are diligent about keeping their appointments. Advance notice allows us to fill the spot and keep the office running efficiently. Cancellations with less than 24-hour notice or not showing up are difficult for us to fill.
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We require that you give our office 24 hour notice if you need to reschedule your appointment. This allows for other patients to be scheduled into that appointment.
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We do allow for one (1) missed appointment as a courtesy. Any additional missed appointments will be charged a fee of $60 for a hygiene appointment and/or $75 per hour for a doctor’s appointment. This charge cannot be billed to insurance. No future appointments will be scheduled until this fee is paid.
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After two (2) missed appointments, we may require you to be on a “call-in only” basis where you would call in the morning to check for any available appointments that day. We will also place you on a “short notice” list if appointments open up in the schedule.
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After three (3) missed appointments, you risk being dismissed from the practice.
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If you have any questions, please feel free to contact us at:
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info@brungofamilydentistry.com
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100 Oakwood Avenue
Suite 200
State College, PA 16803
814-237-4300
