OFFICE & FINANCIAL POLICY
Thank you for choosing us as your dental care provider. We are commited to your treatment being successful. Please understand that payment of your bill is considered part of your treatment. The following is a statement of our Office and Finacial Policy, Which we require you to read and sign prior to any treatment and will be kept in your file for all future treatment and services.
ALL PATIENT MUST COMPLETE OUR PATIENT INFORMATION SHEET BEFORE SEEING THE DOCTOR
Usual and Customary Rates (UCR)
Our practice is committed to providing the best treatment possible for our patients. We charge what is usual and customary for our area. Please be aware that some and perhaps all of the services provided may be "non-covered" by your insurance policy. You are responsible for payment in full regardless of any insurance company's arbitrary determination.
Cancellation Policy
In order to serve all patients to the best of our ability we do require a 48 BUSINESS hour cancellation/reschedule notice. If less than 48 bisiness hours notice a $50 cancellation fee will be applied. Your treatment will be much more effective if you follow your doctor's guidelines and stick to your treatment schedule. Please help us to serve you and all of our patients better by keeping scheduled appointments.
Accounts sent to collection for non-payment will be assessed a $35 collection processing fee.
Thank you.
I HAVE READ THIS OFFICE & FINANCIAL POLICY. I UNDERSTAND AND AGREE TO ALL THE TERMS LISTED ABOVE.