New Patient Form

I hereby declare that I have read, understood and answered the above questionnaire to the best of my knowledge.
I authorize my healthcare provider to collect, use and disclose personal information concerning any claims submitted on my behalf
with the insurer and/or plan administrator and their service provider for my treatment.
I understand that my personal information collected by Cayman Dental Services is kept private and information protection protocols
to protect my information are followed.

Cancellation Policy:
We require 24 hours notice prior to cancelling an appointment with us, otherwise a cancellation fee may be charged