Timely Arrivals: We strive to make every dental visit as comfortable and fun as possible. The entire time sched- uled for your child is used in order to focus exclusively on making his/her visit as productive as possible. The doctor will make every possible effort to see your child at the scheduled time, and requests the same courtesy from his patients. If you are more than 10 minutes late for your appointment, we reserve the right to reschedule the appoint- ment.
Parent Policy: Parents are welcome to come back during examinations, cleanings, and the administration of nitrous oxide. For all other purposes, we ask that you allow our staff to guide your child through the visit. When a patient is near, the child concentrates their attention on the parent, not us. That makes it difficult for use to communicate effec- tively with the child. Please give us the opportunity to attempt treatment that our experience has shown provides the best results. Parents will remain in the waiting room during all surgical procedures.
Payment Policy: In an effort to keep costs down, all co-pays are due when services are provided. For your pay- ment convenience, we accept Visa, MasterCard, Discover, Paypal, and Debit. We require accounts be brought up to date within 30 days, failure to do so will result in cancellation of future elective appointments.
Dental Insurance: As a courtesy to our patients who have dental insurance coverage, we will be happy to file the claim electronically. An estimate of your uncovered portion is due at time of service. Although we endeavor to be knowledgeable about the various insurance plans, it is your responsibility to know your policy benefits, limitations and exclusions. We do not treat based on insurance. We treat based on ADA guidelines and what is best for your child’s overall health. In the event the insurance claim is not processed within 30 days, we will follow up with your carrier. However, further delays caused by the insurance company will require you to make full payment to our of- fice. You will need to contact the insurance company directly for reimbursement. Your signature below indicates that the assignment of insurance benefits will be sent directly to our office. If the insurance company issues the payment directly to you, you will be responsible to make payment in full at the day of service.
Return Check Fee: Returned checks are subject to a $25 fee.
Finance Charge: A finance charge of 18% or (1.5% MRP) will be automatically added to accounts that have a balance older than 30 days.
Billing Fee: All payments (co-pays) not made at time of service are subject to a $1.65 fee.
Broken Appointment Fee: Much time and preparation are invested in each appointment reserved. Last minute/ same day cancellations and no shows waste valuable time that could have been devoted to a patient in need, espe- cially for those having pain and discomfort. Therefore, we require 24 hours notice for cancellation/rescheduling.
Failure to do so will result in a $35 Broken Appointment Fee for each appointment per child.
We reserve the right to discharge families after two missed appointments.
Your signature below indicates that you have carefully read the preceding information and agree with the policies stated therein.