Financial Policies

We are committed to providing you with the best possible dental care. In order to begin a long lasting professional relationship, we ask for your understanding of and cooperation with our financial policies.

We ask that you realize that we don’t work for an insurance company. Rather we work 100% for our patients. We feel that insurance can be a great benefit for many patients and want you to know we will do everything in our power to ensure you get every benefit allotted in your insurance contract. However, the treatment we recommend and the fees we charge will always be based on your individual needs, not your insurance coverage.

We will submit your claims and receive corresponding payments. You will be responsible for making any estimated co-payments in full at the time of service. We will be happy to submit your insurance and collect payment from them provided we have verified eligibility. Any remaining balance after the insurance payment has been received will be due upon receipt of statement.

Financial alternatives for extensive dental treatment can be discussed and approved by our financial coordinator. These alternatives are not to be considered permanent arrangements.


1) When appropriate, we will be happy to submit a pre-treatment estimate to your insurance at your request after you have provided appropriate insurance information.

2) Accounts exceeding 90 days since the last payment will be reviewed for collection by a third party. If you receive a statement you do not understand, please call us immediately. DO NOT IGNORE the statement. Communication is key to our relationship.

3) If an account requires collection by a third party, all attempts to collect your debt will be done by the collection agency. We sincerely hope these measures will never become necessary.

4) Unpaid insurance claims exceeding 90 days or after multiple attempts to file with the insurance carrier will become the patient's responsibility and you will be required to pay the balance in full.

5) As of January 1, 2009, we no longer submit secondary insurance. We will provide you with the proper information but it is the patient's responsibility

6) A $75 fee will be charged to your account for each missed appointment and appointments cancelled within 24 business hours. We appreciate your respect for other patients who can utilize your reserved time and your respect for our time. We extend the same courtesy.

7) There will be a $25 charge for all returned checks, payable by cash or credit card only. Checks which are not rectified immediately will be surrendered to a third-party collector for legal action.

If you have any questions concerning the above information, please do not hesitate to ask. We are here to help you!

I have read and understand the above information.

Online Signature×
Draw your signature inside the box Clear