Our goal is to provide each patient with the finest dental care in a professional environment, which inspires trust and confidence. Our dental office is a business that must be managed efficiently if we are to continue serving our community with quality comprehensive dentistry. Our fees are fair and reflect the care and expertise with which we treat each patient.
To reduce billing and bookkeeping expenses, we ask that all accounts be paid at the time services are rendered.
PAYMENT METHODS: We accept cash (includes money orders & cashier’s checks), personal checks, VISA, MASTERCARD, AMERICAN EXPRESS and DISCOVER credit cards. Payment is due and payable at the time of service.
CARE CREDIT: If you need extended payments, we have an option, which is excellent. Care Credit offers a line of credit for dentistry, which allows you to pay minimal monthly payments. Our office offers up to 12 months interest-free period for qualified balances. The application can be processed in our office or completed online. Once approved, we can process your balance immediately. You will then make your monthly payment directly to Care Credit.
DENTAL INSURANCE: As a service to our patients, we will process insurance claims through our office. Because we do not work directly with any Dental Insurance, patients will be required to pay the full balance of services provided. We will process the insurance claim and insurance reimbursement will go directly to the patient.
FINANCE CHARGES: If a statement becomes necessary, and is past due, a 1.5% per month finance charge will be assessed on the unpaid balance. Any returned or denied checks will be assessed a $50 charge. Accounts over 60 days past due are subject to be turned over to a collection agency.
CANCELLATIONS: Your appointment time is reserved especially for you. If you are unable to keep your appointment, please give us at least 48 hours' notice. Otherwise, you may be charged a broken appointment fee.
I have read and understand all of the information on this form. I understand and agree that I am responsible for all treatment fees on my account. I am aware that if my account becomes past due I will be assessed a 1.5% (18% annual) finance charge on the total balance.