Thank you for choosing us for your dental needs. In an effort to provide quality care to our patients and to avoid any misunderstandings, we would like to inform you of our office policy regarding payment for services rendered.

Payment is expected at the time treatment is performed.

As a courtesy to our patients with dental benefits, we will submit your claim to your primary insurance company. Any portion not expected to be covered by these benefits is the responsibility of the patient and due at the time the service is rendered. This amount will include deductibles and co-payments. If benefit amounts are less than expected, you will be billed for the difference and payment is due within 10 days.

Dental benefits are contracts between the policyholder, their employers and the insurance company. We are not party to this contract.

We will make every effort to assist you with any benefit questions, however, we suggest that you be aware of what benefits you have available. Ultimately, you are responsible for the balance.

We will make every effort to assist you with any benefit questions, however, we suggest that you be aware of what benefits you have available. Ultimately, you are responsible for the balance.

Marital status is not a consideration under any circumstances. Decreed custody or lack thereof, does not alter financial responsibility. The parent accompanying the child/minor on the day of service will be considered the responsible party.

For your convenience, we accept: Cash, Check, Visa, MasterCard, and *Care Credit

* A dental credit card payment program. Ask our staff for details.

Bookkeeping Rewards

• 5% Reward - pre-payment of entire fee upon scheduling of appointment.

• 5% Senior Reward (60 years old qualifies) not to be used in conjunction with assignment of benefit or prepayment reward

Even if you have dental insurance, it is acceptable to take advantage of the full 5% pre-payment bookkeeping rewards. Simply make full payment minus the bookkeeping reward. We will file your insurance forms and instruct your insurance company to send payment directly to you.

Overdue Accounts

1. Finance charges of 1.5 % per month will be added to overdue accounts.

2. Accounts over 60 days old will be sent to a collection agency and will have additional fees added to their account. In the event your account becomes delinquent, you will be responsible for collection fees, attorney fees and court costs.

3. There is a $25 charge for returned checks. If a check is returned and not paid within 7 days of return date, legal action may be taken for collection. Any costs associated with collection of returned checks will be assumed by you.