My First Visit

This is where you explain to your prospective patients the experience they should expect upon their initial visit. This is also where you can provide information that will help a new patient find your practice and arrive to their appointment prepared for a successful visit.

Some examples are, how to find your office once they are in the building, what types of amenities will be available, and what forms they can prepare before their appointment. (400-500 characters)

Financing & Insurance

We are delighted to welcome your child to our practice and we are pleased that you have chosen us to serve your child’s dental needs.

PAYMENT IS EXPECTED AT THE TIME THAT SERVICES ARE RENDERED AND IS THE RESPONSIBILITY OF THE ACCOMPANYING ADULT.

Payment methods: we accept all major credit cards, personal checks*, cash.
(*All returned checks are subject to a fifty dollar ($50.00) service charge.)

DENTAL INSURANCE

We are in-network providers with Delta Dental. We are considered out-of-network providers with other insurance plans. We are please to accept payment directly from your PPO insurance – please verify with our staff if you are not sure if your insurance provider is included in this policy. What your insurance doesn’t pay is the patient/parent’s responsibility (you are responsible for the difference in what they pay). We do not participate with any HMO/DMO or Medicaid plans. At times an estimated co-payment is requested from you at each appointment as service is rendered. This is determined by your benefits within your plan, not our office.

Please understand that we file dental insurance as a courtesy to our patients. We are not responsible for how your insurance company handles their claims or for what benefits they allow on a claim. We can only assist you in estimating your portion of the fees. We cannot guarantee what your insurance will pay for each claim nor can we assume responsibility for the accuracy of any insurance information. It is your responsibility to understand your insurance policy and terms.

You are responsible for payment of any balance due not paid by your insurance company, including unpaid deductible amounts. Although we try our best to estimate as accurately as possible, the final amount your insurance will actually pay is not determined until they issue a claim check to us. If there is an outstanding balance to your account past due 90 days we have the right to send the account to a collection agency and your account balance plus any fees incurred from attempting collection will be owed. Please help us avoid this by paying your portion promptly.

MISSED APPOINTMENTS

We ask for your utmost courtesy regarding your scheduled appointments. If you are unable to keep your child’s appointment please allow at least 24 hours prior to the appointment time if you must cancel or reschedule. We understand that unforeseen emergencies do occur, however, we reserve the right to charge a $50.00 fee for repeated last minute cancellations and broken appointments.

TWO OR MORE CONSECUTIVE BROKEN/NO SHOW APPOINTMENTS WILL RESULT IN DISMISSAL FROM THE PRACTICE.

Patient Forms

HIPAA Privacy Notice

DOWNLOAD FORM

General Consent

DOWNLOAD FORM

New Patient Health History

DOWNLOAD FORM

Want to schedule an appointment?

Contact us to schedule