Please remember that we are here to serve you in a comfortable and professional atmosphere. Our goal is to provide you with the very best quality of dental care.

Insurance And Payment Policies

Fees for service at our office will be requested at the time of your visit. For treatment involving fees above $500.00, special financial arrangements may be discussed with our office manager or financial coordinator.

For patients with Dental Insurance:

We will file your claim for you at no charge, however, we ask that your deductibles and your estimated portions (20-60%) be paid as services are rendered. Although we gladly file dental insurance claims, any and all account balances are ultimately your responsibility. All insurance benefits are assigned to the Doctor, unless services are paid in full the day of treatment.
Please note for your convenience, we do accept VISA, MasterCard, Discover, and Care Credit as well as checks and cash. There will be a $35.00 fee for all returned checks.

Office Policies

Your appointment time is set aside as a reservation made especially for you. We ask for courtesy to the Providers and to other patients that you make every attempt to keep your reserved appointments. If you must change or miss an appointment, we would appreciate a 48-hour notice. Missed/cancelled appointments without proper (48 hour) notice could result in a broken appointment charge of $25.00 per hour reserved and/or no reappointment if it is a repeated issue.
We realize that many families are in a state of change. In order to keep our accounts clean and eliminate any uncomfortable situations for you, we have chosen NOT to become involved in any agreement, understanding, and/or court order regarding reimbursement from the absent parent. The financial obligation is the responsibility of the parent that signs the consent and financial policy. No Exceptions will be made to this policy.
We will be fair in working out special finances with you, but please also be fair to us with your commitments. If, for any reason, your account becomes delinquent without payment for more than 90 days, then your account will risk being sent to a third party (collections) due to non-payment.
There is an interest fee accrued on all accounts (1% of the account balance per month, up to 12% per annum) with balances 30 days and over, regardless of payment arrangements. Should the account be forwarded to a third party (Collections) you will be responsible for all related collection fees and interest added to your account.
Please allow a minimum 24 hour notice for request of duplication of chart and x-rays.

I have read and understand all the above information. The undersigned hereby authorizes the Doctor to perform those diagnostic and treatment procedures, including local anesthesia and sedation, deemed necessary. If I ever have any change in my health or change in my medication, I will inform the Doctor at the next appointment. For insured patients, my signature below authorizes assignment of insurance benefits to the Doctor for services provided to me or any member of my family covered under my insurance plan and authorizes the release of dental records to my insurance company.

You agree to reimburse us the fees of any collection agency, which may be based on a percentage at a maximum of 50% of the debt, and all costs, and expenses, including reasonable attorney's fees, we incur in such collections efforts.