Dear Responsible Party,
We are delighted you chose our practice to provide your child's dental care. Our goal is to provide the highest level of care in a friendly and courteous manner. The Doctor/Patient relationship is a mutually beneficial relationship and requires the commitment of both parties. In order for our practice to provide your child with the appropriate dental care, we need you commitment to our policies. PLEASE READ AND INITIAL EACH POLICY:
1. If you have private dental insurance, please provide the front office staff with your card so that your benefits can be obtained. Please keep in mind that dental insurance is a CONTRACT BETWEEN YOU AND THE INSURANCE COMPANY. As a courtesy, we will file insurance claims for you. We cannot guarantee coverage for any treatment. ALL co-payments, deductibles and fees for non-covered services are to be paid at the time of service.