Important for Our Patients
Dental Insurance & Payment Policy:
We are glad to help you in obtaining the maximum reimbursement from your dental insurance plan. Most plans only assist with a portion of the dental fee, which means you will be responsible for your total treatment fee at the time of service. Once your plan has been verified, we will file the claim on your behalf as a courtesy to you. Payment is expected at the time of service, unless prior arrangements have been made. For your convenience we accept: Cash, Personal Check, VISA, MasterCard, Discover, American Express, Debit cards and CareCredit. In the case of a returned check, there will be a $30 charge added to the total amount due.
I agree to be financially responsible for the cost of all services rendered to the patient by this office, and, I understand that if payment is not made when due, I agree to pay interest on the balance at 1.5 % monthly (18 % annually). In the event legal action results I, the undersigned, accept the fee charged as a legal and lawful debt and agree to pay said fee, including any/all collection agency fees (33.3%), attorney fees, and/or court costs if such be necessary.