FINANCIAL POLICY and AGREEMENT

Thank you for choosing us for your dental needs.  Our mission is to deliver the best and most comprehensive dental care possible. We strive to provide optimal care that is timely, easy, and manageable for our patients.  Our financial arrangements are based on an open and honest discussion of recommended treatment options, respective fees and patients’ financial capabilities.  To confirm your understanding and agreement with our policies, please read the following.

PAYMENT:  Payment in FULL is due at the time services are rendered unless prior financial arrangements have been made.  We accept Visa, MasterCard, Debit and Cash.  Personal cheques are not accepted.

APPOINTMENTS FOR CHILDREN: We invite one parent to stay with very young children during the initial examination. For future appointments, we request you allow your child to accompany our staff through the dental appointment. We can usually establish a closer rapport with your child when a parent is not present. Our purpose is to gain the child's confidence. For the safety and privacy of all patients, siblings or other children should remain in the reception area with a supervising adult.

APPOINTMENT SCHEDULING: A deposit payment may be due at the time of scheduling to secure your reserved appointment with our dental service providers.  The amount of deposit is dependent upon the quantity of appointment time reserved.

If you choose to cancel or reschedule your reserved appointment, we request you provide the minimum notice of 3 complete business days’ advance notice.

This notice allows the dental team a minimal amount of time to offer your reserved time to another patient. We must speak with you live to cancel or reschedule an appointment. Messages left after business hours or not personally answered by the dental office staff during normal business hours Tuesday through Saturday will not be honored.  THE OFFICE IS CLOSED ON ALL MONDAYS AND SUNDAYS.

A minimum fee of $75 per appointment times reserved will be charged to you for cancelled or failed appointments if you do not provide adequate minimum notice as described above.

DENTAL INSURANCE AND ACCOUNT BILLING:  Our office is committed to helping patients maximize their benefits.  Insurance policies vary greatly.  Therefore, owing to the complexity of Insurance contracts, you are fully responsible for knowing your own insurance plan and what you are not covered for.  Treatment is recommended based on what you need NOT on what you are covered for.  As a courtesy, we will submit your dental insurance claim to your dental insurance company.  Your estimated payment for services is payable at the time of service. 

An estimated treatment plan will be presented to you prior to any treatment for your consent.

SERVICE CHARGES:  Service charges are applied on all overdue accounts.  We understand temporary financial problems may affect timely payment of your balance in some cases.  In those situations, we encourage you to communicate any such problems immediately to our Administrative team; they can be reached during regular business hours.

Financial Consent and Authorization for Treatment

We wish to stress that the financial responsibility for services rendered rests with the patients and his/her family, regardless of any insurance coverage; your insurance policy is a contract between you and your insurance company.  We cannot guarantee payment or coverage of your claim. 

I agree to be financially responsible for all charges for all services and materials not paid by my dental plan or covered by my plan if applicable. To the extent permitted by law, I consent to the dental office’s use and disclosure of my protected health information to carry out payment activities in connection with the insurance claim.

I hereby authorize and direct payment of the dental benefits, otherwise payable to me, directly to service providers at Markham Dental – General and Cosmetic Dentistry.

I agree to pay all fees and charges rendered at Markham Dental – General and Cosmetic Dentistry for myself and my family.  I agree to pay all charges when presented with a statement, unless prior credit arrangements are agreed upon in writing.

 I understand and agree, regardless of my insurance status, I am ultimately responsible for any unpaid balance on my account.