We are committed to providing you with the best possible dental care and we are pleased to discuss our professional fees with you at any time. We feel your clear understanding of our financial policy is important to our professional relationship. Please ask if you have any questions about our fees, financial policy or your responsibility.

• All patients must complete our Patient Registration Form before seeing the doctor or hygienist.
• Full payment or insurance co-payment is due at time of service.
• We accept cash, checks, Visa, MasterCard, Discover, American Express and Care Credit.

Adult Patients

Adult patients are responsible for full payment at time of service.

Minors Accompanied by Adult

The adult accompanying a minor and his/her parents or guardians, are responsible for payment at time of service.

Unaccompanied Minors

The parents or guardians are responsible for full payment at time of service. Non-emergency treatment will be denied unless charges have been pre-authorized.

Insurance

If you have insurance, as a courtesy to you, we will assist you in receiving maximum benefits available including full utilization of dual coverage. By doing so, your out of pocket expenses will be minimized and in some cases MAY result in some services being covered at 100% (between two insurance companies). However, if you are paid directly by the insurance company, you then become responsible for your total account balance and payment would be expected immediately. You, as a patient, are always responsible for co-payments, deductibles, and any charges not covered by insurance.

Other Coverage

If you are covered by Workman’s Compensation, automobile insurance (due to an accident), or any government program, please discuss your payment situation with our Account Manager prior to date of service. Prior authorization will be required.

Delinquent Payments

It is our policy to charge a late payment fee of 1.5% on outstanding patient balances after the balance has been aged for 60 days, if payment has not been made within 15 days of the statement due date.

Thank you for understanding our Financial Policy. Please let us know if you have questions or concerns.