LAST MINUTE CANCELLATIONS OR MISSED APPOINTMENTS

Our practice is dedicated to quality care and exceptional service. We respect the importance of your time and work very hard to schedule appointments that accommodate the busy scheduling needs of all our patients. In return, we ask that patients make every effort not to change reserved appointments. When appointments are missed or little notice is given, other patients who need an appointment have to wait. If an appointment needs to be changed, we request a week notice. If a week notice is not possible, WE REQUIRE AT LEAST. A 24-HOUR NOTICE FOR CONSULTATIONS AND FOLLOW-UPS AND 48-HOUR FOR ANY PROCEDURE so THAT WE MAY ACCOMMODATE OTHER PATIENTS. A charge of $75.00 will be applied to broken or missed appointments without 24-hour notification; this fee cannot be billed to your insurance company and will be your direct responsibility. No future appointments can be scheduled without payment of this fee.

FOR PATIENTS WITH DENTAL INSURANCE COVERAGE

Most insurance plans are not designed to pay the entire fee. Many policies have deductibles and co-payment clauses that limit their liability. We check each patient's insurance and are given ESTIMATED amounts as far as what is remaining on the policy and the percentage of coverage; all information given from insurance companies is subject to review and is ONLYAN ESTIMATION. Therefore, we require that the estimated portion, not covered by insurance, be paid at the time each treatment is rendered. If necessary or requested, we will submit a pre- authorization to clarify your insurance coverage.

In the event there is an overpayment, we will either credit your account or refund the overpayment to you, whichever you prefer. Also, if there is any remaining balance due after the insurance portion has been paid, YOU WILL BE RESPONSIBLE FOR PAYING THE BALANCE WITHIN 30 DAYS. All returned checks are subject to $50.00 service charge that will be added to your account balance.

If you should have any questions regarding your dental benefits, our staff will be happy to assist you to the best of our abilities in determining your coverage. Remember that your dental insurance is an agreement between you and your insurance company. Due to the Privacy Act, many questions must be answered by the policy holder and given directly to the insurance

The goal of our office is to constantly strive to provide you with the best dental care available today. We are proud of the quality of services that we provide and we are open to suggestions. However, in case of any grievance, the patient or patient's responsible party agrees to pay all cost and reasonable attorney fees if suit were instituted here under.

THANK YOU FOR YOUR COOPERATION!