Financial Policy

Dear Parents:

Welcome to our practice and thank you for choosing us as your child’s dental health care provider. We wish to advise all new parents of our policies and procedures to prevent any misunderstanding regarding our services.

• Please provide us with any previous medical/dental records to ensure complete care.
• At your initial visit, you will be asked to complete a registration form. This form is to be updated when any changes occur to your insurance or personal information.
• You will be asked to present your insurance card and identification at each visit.
• Payment of co-payments and non-covered services is expected at the time of service.
• If a co-payment is not made at the time of the appointment, a $5.00 fee may be charged to your child’s account.
• We will file a claim with your insurance carrier. Any amounts that are denied or unpaid will be billed to you.
• Credit cards may be kept on file and charged for any outstanding balances. Removal of cards on file may be requested in writing
• Our office does not use silver, amalgam for restorations. Some insurances only cover amalgam, so you may owe the difference.
• The adult accompanying the child is responsible for payment at the time of service.
• In cases of divorce or custody situations, we cannot become involved in mediating financial arrangements between parents.
• Our fee for returned checks is $35.00. If two returned checks are received within any period of time, we reserve the right to request future services be paid with cash or credit card.
• Our office has a tardy policy. If you are more than 10 minutes past your scheduled appointment time, you may be asked to reschedule.
• Our appointment times are limited. Therefore, we have developed a dismissal policy for any family that misses or cancels 3 appointments without adequate notice. Please call at least 24 hours in advance of the scheduled appointment to cancel.
• If we do not receive confirmation for existing appointments, we reserve the right to cancel or reschedule that unconfirmed appointment.

We look forward to serving your child’s health care needs. If you have any questions regarding these policies, please contact our office manager, at (412) 538-0010