Financial Policy
FINANCIAL POLICY
Thank you for choosing our dental practice as your dental care provider. We are committed to providing the optimum dental care for you and your family. Please understand that payment of services rendered is a part of your treatment. The following is a statement of our Financial Policy which we require you read, consent and sign prior to any treatment.
- All patients must completely fill out and sign the Health History form and Financial Policy form before receiving any service.
- We accept all major credit cards and cash for payment. No checks or money orders accepted.
- We will attempt to verify dental insurance. Please understand that the benefits quoted to us from the insurance company are not a guarantee of payment. Benefits can only be determined once a claim is processed by your insurance carrier. It is your responsibility to fully understand the benefits of your insurance plan. Please note the insurance contract is between you and the insurance, we are not a party in said contract.
- We will prepare and submit insurance claims for the treatment rendered. However, the balance remaining will be your responsibility if the insurance has not paid the claim or if the insurance does not cover the full billed amount.
- Payment is due the day service is rendered unless prior arrangements have been made with the office manager. This includes your co-payment or payment in full.
- We ask for at least a 48 hour courtesy call if you must change your dental appointment. The office reserves the right to charge $50 for missed appointments if not given the 48 hour notice. If appointments are chronically missed or canceled, the office has the right to dismiss the patient from the practice.
- Patients under the age of 18 must be accompanied by a parent or legal guardian. If a parent or guardian is not present, a signed note must accompany the child and prior notice must be made to the office.