Dear Patient,
We are pleased that you place your dental health in our care. In the interest of your treatment, we kindly ask you to complete this form in full. If you have any questions, we will be happy to assist you. All information is, of course, subject to medical confidentiality.
We thank you for your understanding that this form should be completed once a year.
Important notice
Your time is valuable, and you can expect us to keep your appointments punctually – except in rare emergencies. We thank you for doing the same. We will not charge you for the services scheduled for your reserved time if you reschedule your appointment at least 24 hours in advance.
Please note:
In the case of short-notice cancellations or if you do not show up without timely notification, we reserve the right to charge a cancellation fee in accordance with § 615 BGB (German Civil Code), provided the appointment cannot be given to someone else at short notice.