Patient Financial Policy

Welcome to the office of Dr. Steven Hall. We want to make your visit productive and enjoyable. We are happy to answer any and all questions regarding insurance plans and payment policies.

Our Policy requires payment at the time of service for your visit.

If you are a member of a Dental Insurance Plan and have chosen us as a provider of your care, it is your responsibility to:

• Provide us with information relative to your claim, including insurance card, number, employer, birth date, address, and Social Security number. This information is required on the Patient Registration Form, which we ask that you complete during your initial or subsequent visit
• Pay your deductible or co-pay at the time of service.
• Pay for'services not covered by your insurance carrier.

Insurance claims for your carriers are filed as a courtesy at no charge to you.

• To assist you with your payment, our office accepts Discover, Mastercard, and Visa.
• Personal checks are accepted with proper identification (driver's license or photo ID). An overdraft charge will be added to returned checks.

When your bill is unpaid, a collection agency may be chosen to manage delinquent accounts. If your account is placed with a collection agency, you will be responsible for all costs of collection.

Change of Appointment Policy

• We require a 48-hour notice for a scheduled appointment change.
• Please be courteous, a fee will be a charge for any change in appointment without 48 hours notice. This is not payable by your insurance.

I have read and fully understand my financial responsibilities under this policy.

DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.