APPOINTMENTS: Please remember, the appointment time is reserved exclusively for you. This enables us to better serve each patient. If it becomes necessary, please reschedule or cancel appointments with our office at least two business days in advance. Our office assesses a charge for the time lost due to a late cancellation or missed appointment. As a courtesy, a voice message, text, or email reminder concerning appointment information will be left at the phone number/ email address you provide.
FINANCES: Payment is due at the time services are rendered. We accept cash, checks, Visa, MasterCard, and American Express. A $20 monthly late fee and an interest charge (18% annual percentage rate) will be assessed on all past due accounts. A bank fee will be charged on all returned checks.
DENTAL INSURANCE: As a courtesy to you, we will bill your insurance company for treatment rendered. However, it is the patient’s responsibility to know the current status of their insurance coverage and benefits. Our staff will estimate your co-payment based on the policy information provided by you. This amount will be due at the time of treatment. Actual coverage may vary from our estimate, as your insurance carrier ultimately determines participant eligibility and claim benefits. The financial responsibility for the work you receive in our office is strictly between you and Dr. Turner, regardless of insurance participation.
- I understand and agree to the foregoing office policies and I hereby agree to accept responsibility for full payment of all treatment fees regardless of any insurance payment or participation.
- I consent to any and all examination and treatment which may be deemed advisable, including the administration of local anesthetics and other medications.
- I consent to have the dental office use my cell/mobile phone number to call or text me regarding treatment, appointments, my dental insurance, and my account. I understand I can withdraw my consent at any time.
- In addition, I hereby acknowledge that I have been given the right to review a copy of this office’s Dental Materials Fact Sheet and the Notice of Privacy Practices as required by California State law.