Today's Dental of Cape Coral

(239) 573-2329

1501 Viscaya Parkway, Suite 1
Cape Coral, FL 33990
Phone: (239) 573-2329
Fax: (239) 573-4867

New Patient Registration Form
New Patient Medical History
HIPPA Privacy Policy Form
Office Financial Policy Form

(All Forms are Downloadable and in PDF format)


As a courtesy, we have provided downloadable patient forms in Adobe PDF Format here. We invite you to save yourself some time on your next visit by printing and filling them out ahead of time.

 
     
     
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IT IS OUR OFFICE POLICY THAT THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS THE RIGHT TO REFUSE TO PAY, CANCEL
PAYMENT OR BE REIMBURSED FOR PAYMENT FOR ANY OTHER SERVICE, EXAMINATION OR TREATMENT WHICH IS PERFORMED AS A RESULT
OF AND WITHIN SEVENTY-TWO HOURS OF RESPONDING TO THE ADVERTISEMENT FOR THE FREE, DISCOUNTED-FEE OR REDUCED-FEE
SERVICE, EXAMINATION OR TREATMENT. ADDITIONALLY, ALL ADVERTISED FEES ARE MINIMUM FEES ONLY. DN15491, DN16634, DN21529
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