This agreement outlines the terms and conditions regarding the non-
refundable deposit required to secure your dental appointment at Xiluet
Smile LLC.
Non-refundable deposit
•Deposit Amount: $250.00 (two hundred and fifty dollars)
•Purpose of Deposit: This deposit secures your appointment and helps
cover the costs associated with preparing for your treatment and
reserving dedicated staff and facility time including Xrays, Pano, Exam
and Xiluet Smile Consultation.
•Application of Deposit: The deposit will be applied towards the total
cost of your Xiluet Smile Design.
Cancellation policy:
•Cancellation will result in forfeiture of the non-refundable deposit.
•A minimum of 48 hours notice is required to reschedule the
appointment.
•Failure to provide the required notice, or a no-show to the appointment,
will result in forfeiture of the non-refundable deposit.
•Rescheduling 3 times in a row will result in forfeiture of the non-
refundable deposit.
•Exceptions for emergencies will be considered individually for
rescheduling an appointment, provided written proof and with the
approval of the office management.
Patient acknowledgment
The patient has read, understands, and agrees to the terms and
conditions outlined in this Dental Appointment Non-Refundable Deposit
Agreement. The patient understands that the deposit is non-refundable if
the cancellation policy is not followed.
If you have any questions or comments about our Refund & Cancellation Policy, please do not hesitate to contact us or, if applicable, submit a verifiable consumer request to us, by either:
- Calling us at 305–615-5500;
- E-mailing us at info@xiluetsmiles.com ; or
- Sending correspondence to: 8396 SW 8th ST, Miami, FL 33144.