Financial Policies
Payment is due at time of service. We accept cash, personal checks, credit cards or care credit. There is a $36.00 fee for all returned checks.
We will be glad to file your insurance for you. However, you will be responsible for deductibles, copays, treatments not covered by your insurance plan, previous balances on your account, etc.
For those patients interested in a payment plan for extensive dental procedures, Care Credit is available. Ask us for information and an application. Approval is usually instant. We have many patients that have found that this is an easy way to acheive the dental results desired with an affordable monthly payment.
Cancelled appointments without 24 hours notice and no show appointments are a burden to us all. They are costly to our practice and prevent other patients that may be on our waiting list from benefiting from that time. This is why we respecfully ask for at least 24 hours notice if you must cancel an appointment. OTHERWISE THERE WILL BE A $30.00 FEE FOR CANCELLED APPOINTMENTS WITHOUT 24 HOURS NOTICE AND A $50.00 FEE PER HOUR SCHEDULED FOR NO SHOWS. 3 or moe broken appointments without sufficient notice will result in permanent dismissal from our practice.
It is very important that each of our patients understand the following: we file insurance as a courtesy to our patients. However, this is a contract between you and your insurance carrier. IT IS THE PATIENT'S RESPONSIBILITY TO HAVE A CLEAR UNDERSTANDING OF THEIR INDIVIDUAL PLAN BENEFITS. We are happy to try an interpret your benefits and do our best to get a clear breakdown from the insurance company, but there are many provisions and stipulations with each individual plan. We ask patient's to understand that the benefits they expect the insurance company to pay are not an exact amount. We merely ESTIMATE, based on the limited information provided by your insurance company. Each claim is subject to review by the insurance company.
If accounts become delinquent, they are subject to a 1.5% monthly finance charge/18% annum/ or $25.00 minimum fee until balance is paid in full. In addition, if it is neccessary to involve a collection agency on severely delinquent accounts, a collection fee of up to 40% will apply, as well as court costs, legal fees anad collection fees required by the outside collection agency.
Consent: The undersigned has read, understands and agrees to the office policies listed above. In addition, the undersigned authorizes the Dr. or his staff to take xrays, study models, photographs or any other diagnostic aids deemed appropriate by the Doctor to make thorough diagnosis of the patient's dental needs. I also authorize the Doctor to preform any and all forms of treatment, medication and therapy that may be indicated. I also unserstand that the use of anesthetic agents embody certain risks. I also assign benefits from my insurance company to the Doctor, unless the balance is paid in full at time of service.
If you are unable to provide a social security number,we need to have a copy of your driver's license or other picture ID.
Please understand that these policies a necessary for our office to run smoothly and efficiently. We appreciate your cooperation and we appreciate you as a patient. Thank You!

Financial Policies
Payment is due at time of service. We accept cash, personal checks, credit cards or care credit. There is a $36.00 fee for all returned checks.
We will be glad to file your insurance for you. However, you will be responsible for deductibles, copays, treatments not covered by your insurance plan, previous balances on your account, etc.
For those patients interested in a payment plan for extensive dental procedures, Care Credit is available. Ask us for information and an application. Approval is usually instant. We have many patients that have found that this is an easy way to acheive the dental results desired with an affordable monthly payment.
Cancelled