PRINTABLE FORMS
for your first visit

---

Insurance

We accept and file for almost all dental insurance plans. We are preferred providers for:

Financial Policy

This statement is to inform you of our financial policy. We are committed to providing you with the highest quality dental care using only the best material and technology available in the market today. We are also committed to providing you with up-to-date information and educational tools so that you may fully participate in maintaining optimum oral health. Our financial policy is intended to facilitate excellent service to you while maintaining our administrative costs.

Payment is due at the time service is provided. Our office accepts cash, personal checks, MasterCard, Visa, American Express, and Discover. Outside financing is available upon request and approved credit.

As a courtesy, for those of you with dental insurance, we will assist you in processing your insurance claims. In order for our office to file your claim, you must bring proof of current dental coverage to each appointment. The portion not covered by insurance is due when services are provided.

All charges are ultimately the responsibility of the patient regardless of insurance coverage. We must emphasize that as your dental care provider, our relationship is with you, our patient, and not with your insurance company. Our office is not a party to that contract or any possible restrictions.

Balances older than 60 days will be subject to collection fees and/or finance charges at a rate of 2% per month (24% annually). Additionally, charges may be incurred for returned checks, broken appointments and appointments cancelled without 48 hour advance notice.

If you have any questions regarding our financial policy, please do not hesitate to ask. We are committed to providing you with the most positive experience in dental care.