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.
Patients without dental insurance or out of network insurance understand that all dental services are charged directly to the patient and that he or she is
personally responsible for payment of all dental services. This office will help prepare the patient's insurance forms or assist in making collections from insurance
companies and will credit any collections to the patient's account. Any balance not covered by insurance is patient responsibility.
In consideration for the professional services rendered to me by this practice, I agree to pay the charges for the services at the time of treatment, or within five
(5) days of billing. I further agree that the charges for services shall be as billed unless objected to, by me in writing, within the time payment is due. I further
agree that a waiver of any breach of any time or condition hereunder shall not constitute a waiver of any further term or condition and I agree to pay all costs
and reasonable attorney fees if suit instituted hereunder.
Payment is expected at the time of your visit.
For your convenience we accept Cash, Check, Visa, MasterCard and Discover. We offer patient healthcare financing through Care Credit.
There is a $50 fee for missed appointments and $29 fee for returned check.