• 908 N Howard Ave #103Grand Island, NE 68803
  • 308-382-1890Call us today!
  • Book An AppointmentM-Th: 8a-5p F: 8a-12p

Patient Forms

All patient forms may be printed and completed at home. Please make sure you bring the completed forms with you to your appointment.

Print At Home Versions

Practice Guidelines

No Shows

Missed appointments without prior notification are considered “No Show” appointments. In the event of the first and second No Shows, you will receive a letter advising you of the No Shows. In the event of Three No Shows or missed appointment, Cottonwood Dental will no longer provide scheduled patient care services for 12 months. For 3 months the patient will be seen for emergency services only.


Cancellations of appointments with less than 24 hours’ notice are considered “No Shows”. We are aware of the fact that from time to time unforeseen circumstances may necessitate the cancellation of an appointment; however, a pattern of repetitive scheduling followed by a cancellation will be treated as “No Shows”. Late cancellation of appointments may prohibit other patients from being seen in a timely fashion. We will attempt a reminder call 24 hours prior to routine appointments, if we are unable to reach you in person, we will leave a message.

Late Arrivals

Late arrival for a scheduled appointment leads to inadequate time to accommodate the remaining patients on the schedule. As such, late arrivals of greater than 15 minutes may be required to re-schedule. In addition, those patients who are on schedule and here at the assigned time will be seen first. We will try to accommodate late appointments if time permits.


Cottonwood Dental requires a co-pay at the time of service. It is your responsibility to be aware of limits of your insurance benefits. You will be responsible for your portion of your visit the day of your appointment. If request for payments fail to settle an overdue balance, your account will be referred to a collection agency.

Treating Minors

Patients who are 19 years old, or younger, must be accompanied by parent/legal guardian. If not, the parent must give written or verbal consent to the clinic for person accompanying on their behalf. Procedures cannot be completed until permission is given by a parent or guardian.