Where People Achieve Healthy, Beautiful Smiles

72775 Frank Sinatra Drive Suite A & B Rancho Mirage, CA 92270, United States

72775 Frank Sinatra Drive Suite A & B Rancho Mirage,

CA 92270, United States

Please answer a few quick questions so we can better prepare ourselves to help you:

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What was the reason you couldn’t make it to your appointment?(Select all that apply) *

The appointment time didn’t work for me

The location was too far

I booked with another clinic

I had second thoughts about the treatment

I couldn’t afford the treatment

Other

If other reason you couldn’t make it to your appointment? (please specify) *

How confident were you about showing up when you booked the appointment? *

Very confident

Somewhat confident

I was unsure

I wasn’t planning to come

What could we do to make it easier for you to show up next time? *

What’s the best way to remind you about future appointments? *

Text message

Phone call

Email

All of the above

If we offered virtual consultations, would that be helpful before committing to a visit? *

Yes, that would be great

Maybe

No, I prefer in-person

Would you like us to follow up with a rescheduling option? *

Yes, please contact me

No, not at this time

Full Name *

Phone *

Email *

NEXT

Form banner image

What was the reason you couldn’t make it to your appointment?(Select all that apply) *

The appointment time didn’t work for me

The location was too far

I booked with another clinic

I had second thoughts about the treatment

I couldn’t afford the treatment

Other

If other reason you couldn’t make it to your appointment? (please specify) *

How confident were you about showing up when you booked the appointment? *

Very confident

Somewhat confident

I was unsure

I wasn’t planning to come

What could we do to make it easier for you to show up next time? *

What’s the best way to remind you about future appointments? *

Text message

Phone call

Email

All of the above

If we offered virtual consultations, would that be helpful before committing to a visit? *

Yes, that would be great

Maybe

No, I prefer in-person

Would you like us to follow up with a rescheduling option? *

Yes, please contact me

No, not at this time

Full Name *

Phone *

Email *

NEXT

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Where People Achieve Healthy, Beautiful Smiles

72775 Frank Sinatra Drive Suite A & B Rancho Mirage, CA 92270, United States

72775 Frank Sinatra Dr Suite A & B, Rancho Mirage, CA 92270, USA

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© 2025 COUNTRY CLUB DENTISTRY

This site is not a part of the Facebook website or Facebook Inc. Additionally, this site is not endorsed by Facebook in any way. FACEBOOK is a trademark of FACEBOOK, Inc.