Thank you for choosing us for your dental needs. In an effort to provide quality care to our patients and to avoid any misunderstandings, we would like to inform you of our office policy regarding payment for services rendered.  

Payment is expected at the time treatment is performed.  

As a courtesy to our patients with dental benefits, we will submit your claim to your primary insurance company. Any portion not expected to be covered by these benefits is the responsibility of the patient and due at the time the service is rendered. This amount will include deductibles and co-payments. If benefit amounts are less than expected, you will be billed for the difference and payment is due within 10 days.  

Dental benefits are contracts between the policyholder, their employers and the insurance company. We are not party to this contract. 

We will make every effort to assist you with any benefit questions, however, we suggest that you be aware of what benefits you have available. Ultimately, you are responsible for the balance.  

Marital status is not a consideration under any circumstances. Decreed custody or lack thereof, does not alter financial responsibility. The parent accompanying the child/minor on the day of service will be considered the responsible party. 

For your convenience, we accept: Cash, Check, Visa, MasterCard, and *Care Credit *  

We will file your insurance forms. 

 Overdue Accounts    

A finance charge of $10.00 per month will be added to overdue accounts. 

Accounts over 60 days old will be sent to a collection agency and will have additional fees added to their account. In the event your account becomes delinquent, you will be responsible for collection fees, attorney fees and court costs.  

There is a $35 charge for returned checks. If a check is returned and not paid within 7 days of return date, legal action may be taken for collection. Any costs associated with collection of returned checks will be assumed by you.  

APPOINTMENT POLICY 

Our office makes every attempt to remain on schedule throughout the day. We value your time and will do our best to keep you from having to wait. We reserve appointments for you. In case of emergencies and appointments which run longer than anticipated, we ask for your patience and that you keep in mind that you may be the next one needing our extra attention. 

?As a courtesy, our office will attempt to contact you through text or email two weeks prior to the appointment.  We must receive confirmation of the appointment to avoid a service charge. However, we do ask that patients/parents assume responsibility for their appointment time. 

Broken appointments or short term cancellations (within 24 hours) without proper notification can be costly and unfair to other patients who need appointments. Repeated broken appointments and short term cancellation may be subject to dismissal from the practice. Late arrivals cause schedule delays for those patients who arrive promptly at their appointment time. Late arrivals will be worked into the schedule if time allows or re-appointment to another day.? 

We require 48 hours notice for cancellation or rescheduling of an appointment.  If 48 hours is not given, a $50.00 broken appointment fee may be applied for hygiene and a $75.00 broken appointment fee may be applied for the Doctor.  ?