I give Macleod Trail Dental my consent to store my credit card in Helcim Card Vault and consent to charging this credit card for balances owing after insurance has been collected.

I understand that not all procedures will be covered by my insurance or covered exactly to the percentage specified on my plan. Each individual insurance plan has its own fee guides, rules, and exceptions which are negotiated by the employer or policy holder. These differences are my responsibility to understand and follow. I am aware Macleod Trail Dental will do their best to assist me in understanding the details of my insurance plan; however, they are limited in the information that can be accessed due to privacy laws, and it is ultimately my responsibility to understand my insurance plan, annual maximums, eligible benefits, and covered procedures.

I understand that treatment fees for dental services vary from patient to patient, therefore all fee estimates given before treatment has been assessed by a dentist and/or hygienist are only estimates. This means they could be substantially more or less at the time of billing. Fee estimates given are only reliable if you have seen dentist and/or hygienist who has given one of our dental administrators your treatment plan.