Patients with Dental Insurance
An estimated fee will be collected at the time of visit. We will be glad to assist you in obtaining your total benefits. If your insurance benefits are assigned to this office you are fully responsible for any unpaid balance. Any outstanding insurance accounts of 45 days will be considered due in full and charged to the patient.
Patients without Dental Insurance
Payment for treatment is expected on the date of service. As a professional courtesy a 5% discount will be given to self-pay accounts at the time of visit. We will accept all major credit cards, Care Credit, check or cash.
All Dental Patients
Until credit approval is given by our credit manager, all patients are expected to pay for dental services as they are rendered. I acknowledge the above and furthermore agree that, in the event this account, or any part of it, remains unpaid for thirty (30) days, I will owe 1 ¾% service charge per month or 21% per annum thereafter on the unpaid balance. In case of default or failure to pay the fees herein agreed to, the undersigned further agrees to pay all the expenses incurred in collection procedures including reasonable attorney fees, court costs, and any other costs of collections.