Payment is due at the time services are rendered. For your convenience we accept
cash, Visa, MasterCard, Discover, money order, registered check and most personal
We view your dental benefits as an entity that financially assists you with your dental care and finances.
Your dental benefits are based on a contract between your employer and the dental benefits
company. As a courtesy we will be glad to file your claim for you if you bring 1) your dental benefits wallet card
and 2) all required employer information. You will be expected to make full payment for services
rendered. Once we verify dental benefits status we will, as a courtesy, file the claim on your behalf.
We will request that the benefits check is sent directly to you or if payment received in our office will forward
the check directly to you.
The total balance for the day’s appointed treatment is considered due and collectible
from you upon arrival for the appointment.
We reserve the right to charge and collect fees for broken appointments – (appointments
that are cancelled or broken without 48-hours advance notice.) There will be a charge of
$55.00 per ½ hour of appointment time reserved for your dental appointment.
Appointments are reserved exclusively for you. As a health benefit to you, we may offer
to move your appointment to an earlier time if openings arise.
A Returned Check Fee, Closed Account Fee or Frozen Account Fee of $35.00 will be
added to your account balance and is collectible. This must be resolved before
proceeding with further treatment regarding this account.
Delinquent Accounts must be resolved prior to scheduling further appointments. We
reserve the right to charge collection fees, attorney fees, and all court fees to accounts
forwarded from our office.
Payment plans and financial arrangements can be entered into for comprehensive
dental treatment, prior to commencing treatment. We offer Care Credit and Med-Direct
for extended financing terms.
I have read and understand this financial policy.