Warranty: We guarantee all our work and will replace anything resulting from technique or material error at no cost to you if you maintain regular 6-month maintenances visits and complete all necessary work. Not doing these things will jeopardize the success of the work we perform. We offer this because we use the best material and techniques available.

Privacy Policy: We are committed to keeping all your information private and will not discuss or share personal information except with those authorized by you. Your email is kept private. We fully comply with all provisions with HIPAA.

Consent to Procedures: You authorize the doctors and/or staff at Little Chompers to perform those procedures agreed upon and within the standard of care for you (or at your request, too your minor child or ward). We commit to informing you about all procedures. We encourage you to diligently ask us if you have any questions about any procedures or their necessity, for we want you to be completely comfortable through the entire process.

PAYMENT POLICY: 

• You agree to be responsible for your own dental bill and to keep us updated of your current insurance information.
• We will bill your insurance as a courtesy; However, you are responsible for all services performed and charges received whether covered or not.
• All Co-payments are due at time of service.
• We accept cash, credit cards and checks. We offer 4- and 12-month payment plans, some at 0% interest OCA.
• We charge $30 for all missed appointments without 24-hour notice.
• You agree to pay $30 in late fees and interest charges assessed if your account becomes past due. If your account must be turned over to collections, you agree to pay up to a 40% collection fee of any unpaid balances.

 

I hereby certify that my answers to the forgoing questions are accurate. Since a change in my medical condition or medications can affect dental treatment, I agree to take the responsibility to notify the dentist of any changes at any subsequent appointment.