Patient Information
Payment Options
Forms
New Patient Special
For more information about CareCredit visit www.carecredit.com.
Form more information about Capital One Health Care Financing visit www.capitalonehealthcarefinance.com/dental/.
We look forward to providing you a lifetime of dental health. It is our firm belief that all people who entrust their oral health to us want and deserve the finest dental care that we are capable of providing. After 13 years in private practice, I know misunderstandings can occur when money is involved. We feel that dental care should only be provided when there is a clear understanding regarding fees and payment. Therefore our purpose in providing you this financial information is to acquaint you with our policy for our mutual benefit. We will give you an estimate of costs required in advance of treatment so that you can come prepared for each visit. Once again, the best surprise is no surprise!
Dental Insurance Plans: We will bill your insurance company for payment under these guidelines. It is important for you to know that our professional services are rendered and charged directly to you—not an insurance company. We work 100% for you, not for them. Dental insurance plans pay only a portion of your treatment, and we urge you to be fully aware of the provisions of your dental co-payment policy.
We will electronically file your dental claim if we can confirm your coverage in advance, but all charges for that claim will be payable by you if your insurance company has failed to make their payment within 60 days of being properly billed.
We are pleased to have an opportunity to provide the highest quality dentistry possible in an open and honest environment based on truth and trust. We will do everything we can to live up to the standards you expect and deserve from us as professionals.
We have set up our accounting to accept the payment options listed below:
1. Payment in full is due at the time of Service. Cash, Check, Master Card, Visa, American Express, or Discover are accepted.
2. Payment of your entire treatment plan over $500 in advance qualifies you for a 5% bookkeeping courtesy. The full amount of your estimate has to be paid in advance while making the appointment for your next visit by cash, check, or credit card.
3. 30 - 90 day accounts can be set up with prior approved credit.
4. Third party financing. We know that dental expenses, co-pays and lack of insurance coverage keep some patients from seeing the dentist regularly. We are pleased to provide CareCredit®, which offers a full range of no-interest or low-interest payment options, and Capital One® Health Care Financing™. You must obtain approval prior to scheduling treatment. Our financial secretary can process your application before you leave, or you can apply directly online.
Forms
The following forms can be viewed using Acrobat Reader. Please print and complete prior to our initial visit.
