Office Policies Acknowledgment

Office Policies Acknowledgment

Scheduling Appointments:

Our Office takes patients by appointment only. Same day appointments may be available, so please call to inquire. We attempt to schedule appointments at your convenience and when time is available. We are open two Saturdays a month and closed on major holidays.

Six-Month Follow Up:

We like to schedule your next 6 month cleaning and exam in advance. Please be prepared to schedule a follow up visit when you come in for your initial cleaning and exam. We will notify you when your appointment is getting close by telephone, as well as postcard.

Cancelling Appointments:

The time for your appointment is reserved exclusively for you. This means, if you are ever unable to keep the appointment, please notify us within 24 hours so that we may have an opportunity to fill that time with another patients that needs our care. We realize that unexpected things can arise, but we do appreciate your assistance in this regard.

No Shows:

Your account will be assessed a $50.00 fee if you miss your appointment without any prior notice. We apologize in advance for any inconvenience this may cause; however, it is important that we see patients who are serious and responsible about their dental care.

Fees and Payment Options:

Payment for service is due when the services are rendered. We will clearly explain all treatment costs to you during your consultation. We will make an effort to provide you with a treatment plan that gives you the best possible care for your budget. We are able to accept major credit cards and cash payments for services. If you are interested in a financing option, please ask the front desk for information.

Insurance Policies:

Many of our patients have dental insurance. While your dental insurance policy is an agreement between you and your insurance company, we will be happy to assist you in preparing and sending in the necessary forms. Please remember that no insurance company attempts to cover all dental costs. Dental insurance is meant to be an aid in receiving dental care. Many patients think their insurance pays 90-100% of all dental fees. This is not true! Most plans only pay between 50-80% of the average total fee. Some pay more, some pay less. The percentage paid is usually determined by how much you or your employer has paid for coverage or the type of contract your employer has set up with the insurance company. You must be familiar with your insurance benefits, as we will collect from you the estimated amount insurance is not expected to pay. By law your insurance is required to pay each claim within 30 days of receipt. We will file most insurance electronically so your insurance will receive each claim within days of treatment. You are responsible for any balance on your account after 30 days, whether insurance has paid or not. If you have not paid your balance within 60 days, a finance charge of 1% will be added to your account each month until paid. We will be glad to send a refund to you once insurance has paid us.

Payment to our office remains your responsibility, regardless of how much your insurance does or does not pay. For extensive treatments, most insurance companies require pretreatment estimates. We’ll be happy to supply any information your dental insurance carrier needs and help you receive the maximum benefits.

MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.

We look forward to providing you with exceptional care. If you have any further questions or concerns please ask! We are happy to help in any way we can. Thank you for choosing our office.

Please sign below to acknowledge receipt of our Office Policies. For your record, a copy will be emailed to your address.

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