Thank you for choosing our office for your dental care. We are committed to providing the highest quality care to help you maintain optimal oral health. Please review and sign our Patient Care & Financial Agreement prior to treatment, which outlines your responsibilities regarding payment, insurance and missed appointments.

Payment

Payment is due at the time services are provided. We accept cash, personal checks, MasterCard, Visa, Discover, and CareCredit. Returned checks will incur additional fees, and account balances over 90 days are subject to a $35 late fee.

Insurance

As a courtesy, we will help process your dental insurance claims and provide an estimate of coverage. This is not a guarantee of payment—insurance benefits vary by plan, and you are ultimately responsible for all charges. Coverage may have limitations, exclusions, waiting periods, frequency rules, age restrictions, deductibles, and maximums. Please contact your insurance company for details. Deductibles, co-pays, and non-covered amounts are due at the time of service. If insurance payment is not received within 60 days or a claim is denied, you are responsible for the balance. Our relationship is with you, the patient, not your insurance company. We will assist in processing claims but cannot enter disputes over coverage or payment decisions.

Minors

Parents or legal guardians accompanying a minor are responsible for full payment at the time of service. For unaccompanied minors, treatment consents and payment arrangements must be made in advance, or non-emergency care may be denied.

Missed Appointments and Cancellations

We do our best to confirm appointments by phone, text, or email and request at least 72 hours’ notice to reschedule or cancel. Missed or late-canceled appointments may incur a $100 fee for the first occurrence and up to the full appointment cost for subsequent missed visits. We understand unforeseen situations may arise and will work with you to find a suitable time.

Consent

I have read, understand, and agree to the above terms and conditions. I authorize my insurance company to pay benefits directly to this dental office. I understand that I am responsible for all charges for dental services provided for myself or my dependents, due and payable at the time of service.