If the Responsible Party is NOT the patient, please fill out the following information.
The options for payment will be explained to you after treatment plans have been discussed. Payments may be made in cash, check, VISA, MasterCard, American Express, Discover, or we can arrange third party financing for you.
If you have dental insurance, please provide us with the appropriate information so we can submit claims electronically for prompt reimbursement. As a courtesy to you, we will fill out the necessary forms for your insurance so you are reimbursed directly. We will make every effort to help you maximize your benefits.
Appointments are scheduled to allow sufficient time to attend exclusively to your needs. For appointments which are not kept or cancellations with less than 48 hours notice, we reserve the right to charge cancellation fee.