Thank you for choosing us as your dental health care provider! We are committed to providing excellent dental care in a relaxed and caring environment. The following is a statement of our Financial Policy for you to read and sign prior to your treatment.
FULL PAYMENT IS DUE AT TIME OF SERVICEWe accept: Cash, Checks, Visa, MasterCard, Discover, American Express and Care CreditConvenient Payment Arrangements for Major Restorative Treatment
REGARDING INSURANCE:
USUAL AND CUSTOMARY RATE:Our practice is committed to providing the best treatment for our patients and we charge what is usual and customary for our area. You are responsible for payment regardless of any insurance company’s determination of usual and customary rates.
MINOR PATIENTS:The parent or guardian of the minor is responsible for full payment. If an adult is not present, it is preferred that the payment be sent with the patient
CANCELLATIONS AND MISSED APPOINTMENTS:We require 48 hours' notice if you need to reschedule your appointment. This gives us time to contact another patient who may be waiting for an appointment. If given less than 48 hours notice, a cancellation/missed appointment fee of $125.00 for (hygiene) and a cancellation/missed appointment fee of $225.00 for Dr. McCune will be charged. However, we do realize there may be an emergency or sudden illness that makes notifying us in a reasonable time difficult.
Thank you for reviewing our Financial Policy. Please let us know if you have any questions or concerns.
I HAVE READ AND UNDERSTAND THE ABOVE STATED FINANCIAL POLICY
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