Texas Informed Consent
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Letter: Dismiss Patient
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Letter: Dismiss Patient
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Forms for Patient Termination, Release of Claims, &
Appointment Cancellation Policy:
Patient Release of Claims
$10.00
Patient Release of All Claims:
Release form for settlement of dispute between patient and provider, stating that
"payment constitutes a final and full settlement of any claim I might have against the dentist in this particular case,..."
Patient Termination Letter
$10.00
Patient Termination Letter:
Complies with Texas Administrative Code (TSBDE) Rule 108.5 Patient Abandonment (Click form for more information)
Appointment & Cancellation Policy
$10.00
Appointment & Cancellation Policy:
Cordially written but to the point letter to a patient who has canceled their appointment without prior notice, and advises the patient of the office Appointment & Cancellation Policy.
