We accept cash, personal checks, Visa, Mastercard, American Express, Discover, and Care Credit. Please note, for cash payments; we do not carry change for non-exact payments. Anything paid in cash over the amount due will be kept as a credit on the account for future use. We do not offer in-house payment arrangements.

We will bill all insurance plans as a courtesy, regardless of network participation status. Insurance information must be provided to the office before the day of the scheduled appointment. If sufficient time to verify the dental benefits is not given by the patient, the full office fee will be collected until the office can verify the plan information.

If the office or provider is out of network with the insurance and the policy does not accept assignment of benefits, payment in full is due at the time of service for the offices' full fee. Proof of insurance must be provided when the insurance is added to the account. Payments for estimates patient portions and/or deductibles are due at the time of service. Should there be any balance left after the insurance payment is received, it will be billed to the address on file.

As a courtesy, we will appeal an unjustified insurance denial for services up to two times on the patient's behalf. If, after two appeals, the insurance claim has not paid, the balance will be reassigned to the patient.

There will be a 1.5% monthly finance charge applied to all accounts 30 days or more past due. A statement will be generated each month for balances on accounts and delivered to the billing address on file. After three statements or 120 days, unpaid accounts will be forwarded to an outside collection agency, at which point we will no longer accept payment. Accounts sent to collections will be dismissed from the practice.

Checks that are returned to the office from your financial institution are subject to a $50 returned check fee

If minors are not receiving diagnostic or preventative services, a parent or legal guardian must accompany the minor patient to the appointment. Treatment consents can only be signed by the minor patients' legal guardian; no exceptions will be made. Estimated patient portions will be the responsibility of the accompanying guardian and are due at the time of service.

There is a 48 business hour cancellation and rescheduling policy in place for all appointments. Accounts with cancellations or changes made within 48 business hours of the appointment will be assessed a fee of $50 per reserved hour. Please note that the office is closed Thursdays and Sundays.

Reserved appointments must be confirmed 24 business hours prior to the scheduled time, or they will be forfeited. We will call, text and email to attempt to confirm the appointment before it is removed from the schedule. We offer electronic appointment reminders and confirmations for your convenience.

No-show appointments will be assessed a fee of $50 per reserved hour. After two late cancellations or no-shows, the patient will be required to pay a $100 reservation fee before scheduling any further appointments. If an appointment is failed or cancelled within 48 business hours, the reservation fee will be forfeited, and the process will start again. After two reservation fee forfeits, the patient will be dismissed from the practice. The reservation fee will be released back to the patient after 12 consecutive months of no failed or late cancelled appointments.

Hoover Dental Group has a fragrance-free policy. Some of our patients and employees have multiple chemical sensitivities (MCS). As a healthcare facility, we ask that all individuals coming to our office refrain from wearing scented products such as perfumes, colognes, and strong scented lotions. If a patient appears for an appointment with a strong manufactured scent, they may be turned away.

I attest that I have received, been offered, or instructed where to find a copy of Hoover Dental Group's privacy practices.

Click here to refer the Notice of Privacy Practices Form.

I attest that I have received, been offered, or instructed where to find a copy of Hoover Dental Group's dental materials fact sheet as required by law.

Click here to Read Dental Materials Fact Sheet.

I certify that I have read and understand this packet in its entirety. To the best of my knowledge, I have answered every question completely and accurately. I will inform my dentist of any changes in my health and/or medication. Further, I will not hold my dentist or any other member of Hoover Dental Group responsible for any errors or omissions that I may have made in the completion of this form.