Policies Form

We keep the health and financial information of our current and former patients private, as required by law, accreditation standards, and our rules. This notice explains your rights. It also explains our legal duties and privacy practices. We are required by federal law to give you this notice.

We are glad to assist you in obtaining the maximum benefit from your dental insurance. Once your coverage has been verified, we will accept assignment of payment from your insurance company. Most plans only cover a portion of the dental fee, which means you will be responsible for the deductible and estimated co-payment. Your co-payment is expected to be paid at the time of treatment.

For your convenience, our office will gladly process your insurance on your behalf, understanding that the agreement you have with your insurance is between you and the insurance company. Therefore, you are responsible for any outstanding charges after the insurance has made their payment.

If you have any questions regarding this policy, please speak with someone at our office prior to the treatment. We will not alter financial arrangement once the treatment has started.

Your co-payment is required at the time the treatment is being rendered. The amount will be applied towards the out-of-pocket expense not covered by your insurance. This estimated portion of the payment is made soon after the time of your appointment same day. For your convenience, we accept Visa, MasterCard, American Express, as well as FSA, HSA cards. We also accept Care Credit. Any balance that is 30 days overdue will be charged to the credit card on file.

Our goal here at Westwood Dentistry is for your experience with us to be one of promptness and quality dentistry. We have created a schedule with your busy schedule in mind and make every effort to see you at the appointed time. Because your appointment can range from 1 hour to 2 hours, we request that any change in your appointment take place within 48 hours of the appointment. This will make the time slot available to another patient. We acknowledge that unexpected things can happen, but request attention with this regard. Any cancellation within 24 hours from appointment time or no-show will result in a $50 cancellation fee charged to the credit card on file.

Your signature below confirms that you have read these policies and agree to abide by them. We thank you for the opportunity to care for your oral health.