By Kyle Summerford

Having written forms can help dental practices communicate more clearly with patients. It’s important for patients to understand what’s expected of them. This month’s featured dental form is a No show, missed appointment office policy form, with a Credit card appointment reservation form.  

Are no shows draining your dental practice revenue? It’s time to fight back!

Time and time again, you get the same old patient cancellation excuses. I woke up sick, my boss won’t let me leave work early, my dog/cat needs to go to the veterinarian. These are typical excuses that we tend to hear day after day, over and over again.

Eventually you’ll sit and wonder, are these excuses in fact true? Which patients are actually telling the truth and who is lying? Are they simply not interested in moving forward with their treatment and then deciding at the last minute to cancel their reserved time slot because they don’t care?

After two or three cancellations you should know who your frequent cancellers are, and you should have a way to combat this loss of revenue in your practice.

Use this form, download it, customize it to your practice, integrate it into your new patient packet, and watch it turn your loss revenue into seamless revenue.

Click No show, missed appointment office policy form, or click on the image below, to download the no show form. Also included is a Credit card appointment reservation form.

Download the July form, the Medical Necessity for Waterpik form, here.

The June featured form was the Periodontal Charting Form.

The featured form in May was a Patient Refusal of Recommended Treatment form.

If you would like to share any forms you think will be helpful to your fellow OM’s and DA’s, we ask that you forward them to us for publication. Contact Kyle Summerford at, or Meg Kaiser at

Feel free to download and tailor these forms to suit your practice.