Payment Terms:
- Payment must be made in full for treatment/services on the day of the appointment.
- The practice reserves the right to transfer any unpaid debt to a collection agency. This may include collection fees, which will be the responsibility of the patient.
Accuracy of Information:
- All information provided by the patient must be true and correct to the best of their knowledge.
Cancellation and Rescheduling Policy:
- Appointments cancelled or rescheduled with 16 hours or less notice will incur a charge of 50% of the appointment's total value.
- Cancellations made with 4 hours or less notice, including missed appointments, will incur a charge of 80% of the appointment's total value.
How to Provide Notice:
- Email:
  - Reply to the automatic appointment confirmation email sent after booking, or
  - Email us directly at info@whitforddental.co.nz.
- SMS/Text:
  - Reply with "N" or "No" to the SMS reminder sent two days prior to your appointment.
- Telephone:
  - Call us on 09 530 8461. Please confirm your name, appointment date/time, and whether you wish to cancel or reschedule.
  - If we are unable to answer, leave a message on our voicemail with the required details.

We appreciate your understanding and cooperation in helping us provide efficient and timely care for all our patients.

Declaration and Acknowledgment

By signing this form, I, the patient/parent/caregiver of the patient, confirm that the information provided is true and accurate to the best of my knowledge. I further acknowledge that I have read, understood, and accept the Payment and Appointment Policy/Terms outlined above.

Confidential Patient Questionnaire