Patient Forms

Your Responsibilities and Rights as an MCDC Patient

In order to maintain the reduced fees that MCDC is able to offer our patients, it is critical that we make the most effective use of our time. Missed appointments, late arrivals, and last-minute cancellations prevent us from utilizing our time appropriately, and this affects all of our patients. To help eliminate these occurrences, MCDC has instituted a no-show policy that will be discussed with you at your first appointment.

In addition, before MCDC personnel can treat you, you must consent to allow this treatment to be performed.

Finally, as an MCDC patient, you have a right to expect that we will maintain the confidentiality of your dental records.

The provision of services will not be denied to individuals based on race, color, sex, national origin, disability, religion, or sexual orientation.

Terms of Use
Notice of Privacy Practices

Your First Appointment

When you arrive at the clinic for your first appointment, you will be asked to read some information and provide some personal history:

  • A form confirming that you have read and understand MCDC’s Cancellation policy, Consent for Treatment acknowledgment, and your right to privacy notification.
  • A patient information and health history form that we will scan into your permanent patient record.

You can save time at your appointment by downloading and printing these forms and completing them before you arrive at the clinic. Simply click on the following links to do so:

Appointment Policy & Treatment Consent Form
Patient Health Information Form
Formulario de Información de Salud del Paciente
Nuevas Formas de Pacientes

MCDC’s Promise

Read MCDC’s Promise to Our Patients.