Consent for Services and Financial Policy

We are committed to providing you with the best care possible. As a condition of treatment by this office, financial arrangements must be made in advance. The practice depends upon reimbursement from patients for the costs incurred in their care. Financial responsibility on the part of each patient must be determined before treatment.

If you have dental insurance, we are eager to help you receive your maximum benefits. In order to achieve this, we need your assistance and would like you to understand our policy concerning insurance matters.

As a courtesy to you, we will file your insurance. Please understand that in the event your insurance does not pay within 30 days for any reason, you are responsible for the entire balance. Most dental insurance plans will leave an amount for which you will be responsible depending on the type of procedure you are having. Our payment policy is as follows:

  • If you do not have dental insurance, payment is due for all procedure types as services are rendered unless prior financial arrangements have been made
  • All visits will require payment of your estimate portion on the day services are rendered unless prior financial arrangements have been made. If you have any question regarding your estimated portion, please contact us prior to your appointment date.

We have a financing option available. Please ask our team about this option.

Please be aware of the following:

  1. Your insurance is a contract between you, your employer and your insurance company.
  2. Your insurance carrier may use language such as “Reasonable or Usual and Customary” when referring to payment tables. Please be advised that our fees are based on actual costs associated with providing the highest level of quality, service, and personalized care that we are able to offer. Our fees are comparable to other dentists in the area that follow these standards. If you have additional questions regarding this matter, please discuss with our team.
  3. Not all services are a covered benefit in all contracts. Some insurance companies arbitrarily select certain services that will not be covered.

Please read your insurance policy. If you do not understand your policy, please speak with your insurance agent or your employer.

We require 24 hour notice to cancel/reschedule existing visits with us. If we do not receive such notice, there is a charge of $75 for any missed visits.