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New Patient Forms1. Patient Registration2. Medical History 3. Financial Agreement 4. Acknowledgement of Privacy 5. Privacy Acts
Financial ArrangementsCash / Check / Credit Card Receive a 3% accounting reduction by paying in full at the time of service. For services requiring more than one appointment, the entire balance for the procedure(s) must be paid in advance at the first visit. Your insurance check will then be sent directly to you.
Credit Cards We accept VISA, MASTERCARD, and DISCOVER. We offer these to allow you the most convenience in taking care of your account.
Dental Insurance As a service to our patients, we will file your dental insurance via electronic claims. We work with your insurance company to provide the most accurate estimate of your co-pays. It is the patient’s responsibility to provide the correct insurance information at the first visit. Payment in full is required at the time of service for all non-insured patients. Insured patients are responsible for, and should be prepared to pay all amounts not to be covered by the insurance estimate. With insurance plans paying only a portion of treatment cost, we can only estimate what your insurance company will pay. The maximum time allowed for an insurance payment is sixty days. After sixty days, the patient is responsible for the entire balance.
Payment Plans We
have made arrangements with the Care Credit Company to provide payment
plans. This allows you to complete your dental work without delay and
make relatively small monthly payments. Applications are available and
approval can be determined within ten minutes. For your convenience
you can also apply online at www.carecredit.com |
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