We Welcome New Patients

**PLEASE REVIEW YOUR DENTAL PLAN CAREFULLY TO UNDERSTAND THE EXCLUSIONS/LIMITATIONS OF YOUR PLAN

• We expect your co-pay (amount not covered by insurance) at each appointment. At times when we cannot precisely determine the co-pay, you may receive another invoice for the balance.
• If you have 2 insurances, we will submit to both on your behalf. Depending on limits, you may still have a portion
• We encourage estimates for all services.
• Benefits are a contract between your employer & insurance. Most policies do not cover 100% of the costs.
• Your insurance company pays out on the basis of the premiums you or your company pays. Insurance may cover less than you like because the premiums paid on your plan only allow for a certain level of coverage.
• Due to the privacy act, most insurance companies will only release information to the member, including any other treatment you have already had at any other dental clinic. It is your responsibility to know the details of your plan.
• We can help check your coverage prior to proceeding. These amounts are estimated, and do not guarantee coverage.
• We direct bill your insurance company as a courtesy. If insurance does not pay within 45 days, we reserve the right to request payment in full for service from you and let you collect the insurance funds that are due to you.
• All overdue accounts will be subject to interest charges.
• Should any conditions to my dental plan change, I understand that it is my responsibility to notify the staff.

A specific amount of time is reserved especially for you and we strongly encourage all patients to keep their appointments. If you must cancel or reschedule your appointment, we require at least 2 business days notice to avoid a $50-$100 cancellation fee depending on the appointment that was booked for you. If insufficient notice is given, a $50-$100 charge will be applied to your account that must be paid in order to schedule future appointments. In the rare event that there is a pattern of missed appointments, we will only book same day appointments.