By clicking the submit button, I confirm that I have responded to all of the above questions accurately, and have not knowingly withheld any information. I authorise the dentists and dental hygienists at A+ Dentists to perform diagnostic procedures as may be required to determine necessary dental treatment. I understand that it may be necessary to obtain information from my medical doctor or another healthcare provider in order for me to receive optimal care. I further understand that responsibility for payment of dental services for my dependants and myself is mine, and that payment is required at the end of each appointment. I am also aware that if I fail to attend an appointment or cancel one by giving less than 24 hours notice, there will be a $50 per half hour failure fee charged to my account or deducted from my existing credit, if any, with A+ Dentists
