Signed Date
Date
OoLi Orthodontics Location
OoLi Orthodontist Name
Patient Name
Address
Patient Email
Patient Phone
Patient / Parent / Guardian Name
Patient / Parent / Guardian Email
Patient / Parent / Guardian Phone
It has been brought to the attention of OoLi Orthodontics that above patient has failed to show up for orthodontic appointments. We require that patients remember their scheduled appointments to ensure completion of the orthodontic treatment planned for that day so that your treatment can be finished on time as estimated at the start of treatment
Missed or late appointments prolong orthodontic treatment and may potentially contribute to dental health problems. These problems include loss of tooth enamel, increased risk of cavities and gum disease, and the possibility of injury to the mouth from loose or broken appliances.
Please contact OoLi Orthodontics as soon as possible to schedule an appointment. If you are no longer interested in receiving orthodontic treatment at OoLi Orthodontics, kindly provide us with a written request to forward your records to another orthodontist. If you have decided that you do not wish to continue with orthodontic treatment at all, we recommend that you make an appointment to have the orthodontic appliances removed.
Sincerely,
W.W. Jonathan Park, DMD, MS