Forms

We have provided forms for your convenience so you can save time when you get to our office. These forms require Adobe Reader to view and print. If you don’t have access to a printer, feel free to email them back to us and we’ll have them ready for signature when you come in.

Registration Form

Other forms:

Office_policy
Dental Medical History
Notice of Privacy Practices
Dental Materials Fact Sheet
Receipt of Privacy Practices
Receipt of Dental Factsheet

Cancellation Policy

Cherry Chase Dental has a 2 business days cancellation / rescheduling policy. If you miss your appointment, cancel or change your appointment with less than 2 business day notice, you will be charged $25 per 30 min appointment scheduled.

This policy is in place out of respect for our Doctor and our Hygienist. Cancellations with less than 2 business day notice are difficult to fill. By giving last minute notice or no notice at all, you prevent someone else from being able to schedule into that time slot. We look forward to seeing you at your upcoming appointment.