Thank you for choosing our office for your dental care. It is our mission to provide you with the highest quality of patient care. Please review our financial policy and sign below.
The patient is responsible for payment of their estimated portion of payment at the time of service, unless written financial arrangements have been made.
We calculate your portion based on the most up-to-date information we have by verifying your benefits with your insurance provider, but it is only an estimate. Any amount not paid by insurance is the patient's responsibility and we are not responsible for denials of service by your insurance provider. Insurance benefits are not a guarantee of payment and the patient is responsible for the balance. We encourage you to discuss any concerns or questions you may have regarding your specific plan with your insurance company, as you are their client.
We accept all major credit cards, personal checks, and cash. To make your dental care affordable, we also offer interest-free payment plans for 12 months through CareCredit financing.
We will do our best to contact you prior to your appointment, however, this is a courtesy reminder and you are still responsible for keeping your appointment. Your appointment is just for you. A fee of $100 for the doctor/$75 for the hygiene visits will be charged for appointments that are missed or canceled without 48-hour notice.
We send out regular statements for any balance that may accrue on your account. An interest charge of 5% monthly will be applied to any account with a balance showing no payment activity after 90 days of issuance of the first statement. Though we try to resolve all financial issues as cordially as possible, continued lack of payment will result in the account being sent to a collection agency for resolution. Please speak with our staff for an explanation of financial options available.
I understand and agree to the office policy of Jordan J. Tilden DDS, PC & Associates