Written Financial Policy

Please correct the errors described below.

Thank you for choosing Mikula Dental. Our primary mission is to deliver the best and most comprehensive dental care available. An important part of the mission is making the cost of optimal care as easy and manageable for our patients as possible by offering several payment options.

Payment Options:

You can choose from:

  • Cash, Check, Visa, Mastercard, American Express or Discover Card
  • Convenient Monthly Payment Plans¹ from CareCredit
    • Allow you to pay overtime
    • No annual fees or pre-payment penalties

Please note:

Payment is required at the time of your treatment. If you choose to discontinue care before treatment is complete, you will receive a refund less the cost of care received.

For patients with dental insurance, we are happy to work with your carrier to maximize your benefit and directly bill them for reimbursement for your treatment. ²

Any patient who fails to show or cancels/reschedules an appointment that has not contacted our office with at least a 24-hour notice will be responsible for a $30.00 missed appointment fee.

Any patient who fails to show or cancels within 60 minutes prior to their reserved time will be responsible for a $50.00 missed appointment fee. The fee is charged to the patient, not the insurance company, and is due at the time of the patient’s next visit.

  • Mikula Dental charges $25 for returned checks.

If you have any questions, please do not hesitate to ask. We are here to help you get the dentistry you want or need.

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.

¹Subject to credit approval

²However, if we do not receive payment from your insurance carrier within 90 days, you will be responsible for payment of your treatment fees and collection of your benefits directly from your insurance carrier.

Your information will be encrypted.