Thank you for choosing Danville Pediatric Dentistry for your child’s dental care.
Please read our financial agreement. Sign and date prior to any treatment.
For my convenience, this office may release my information to my insurance company, and receive payment directly from them.
I will pay a $25 fee for appointments broken without 24 hour notice.
Treatment plans sometimes change, and I will be responsible for the work completed on the date of service.
In an effort to make our patients' dental care affordable, payment is required at the time of treatment. If you do not have dental insurance, full payment is due at the time of service. If you have dental insurance, we require an estimated co-payment on the date services are rendered. If your account has an overdue balance, future treatment may be delayed until your balance has been paid in full. For your convenience, we accept cash, check, CareCredit or credit. We do not offer payment plans.