Notice & disclaimer

Sample template. Adapt this notice to your practice, your licenses and your state’s laws.

General information

The information on this website is general and educational. It is not medical or dental advice and does not replace an exam with a dentist. Every patient is different; your diagnosis and treatment are decided at your visit.

Emergencies

For a medical emergency, call 911 or go to the nearest emergency room. For a dental emergency during office hours, call our office.

The form is not for medical information

The appointment form is only for requesting a visit. Please do not send symptoms, medical history, medications, insurance member IDs, card numbers or Social Security numbers. We will talk about your health privately.

Using this site does not make you a patient

Sending the form or reading this website does not create a patient relationship. That relationship begins when we see you at the office.

Insurance, costs and results

We accept many insurance plans, but benefits depend on your plan. Costs are confirmed in writing before treatment. Photos show types of care; results vary from person to person.