Release Form

COMFORTABLE CARE DENTAL HEALTH PROFESSIONALS, P.A.

Wiregrass Family Dental Care welcomes patients with disabilities. If you need an accommodation to receive dental services, we would be happy to provide one. Please contact us at 813-528-8797 to let us know how we may be of assistance. 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 72 HOURS OF RESPONDING TO THE ADVERTISEMENT FOR THE FREE, DISCOUNTED-FEE OR REDUCED-FEE SERVICE, EXAMINATION OR TREATMENT.