Thank you for choosing us !  We are committed to treat your dentally related needs in a successful manner. Please understand that payment of your bill is considered a part of treatment.

The following is a statement of our Financial Policy, which is required that you read and sign prior to any treatment.

All patients must complete our Information Form before seeing the doctor.

FULL PAYMENT IS DUE AT THE TIME OF SERVICES. WE ACCEPT CASH, CHECKS OR VISA/MASTERCARD.

Regarding Non Managed Care Insurance:

We may accept assignment of insurance benefits after your second visit, if your deductible has been met. However, we do require your percent of the bill to be paid at the time of service. The balance is your responsibility whether the insurance company pays or not. We cannot bill your insurance company unless you give us your insurance information. Your insurance policy is a contract between you and your insurance company. We are not a party to that contract. In the event we do not accept assignment of benefits we require that you provide a credit card with authorization to bill that balance to your account. If your insurance company has not paid your account in full within 60 days, the balance will automatically be transferred to your credit card.

Regarding Insurance Plans We Participate In:

All co-pays and deductibles are due at time of service. In the event that your insurance coverage changes to a plan where we are not participating providers, refer to the above statement.

Usual and Customary Rates:

Our practice is committed to provide the best treatment for our patients and charge what is usual and customary for our area. You are responsible for payment regardless of any insurance company's arbitrary determination of usual and customary rates.

Insurance Filing

As part of our service, we may file your insurance claim for you. At the time that treatment options are presented to you, we also will estimate the portion of the cost that it will pay or not. It is important that you understand that the estimate may not accurately represent the actual payment.

We pledge to you that never will we mislead you with regards to your financial situation.

Adult Patient: (Age 18 and over)

Adult patients are responsible for full payment at time of service.

Minor Patient:

The adult accompanying a minor and parent (or Guardian of minor) is responsible for full payment. For unaccompanied minor, Non-emergency treatment will be denied unless it has been pre-authorized to Visa/Master-Card or payment by cash or check at time of service has been verified.

Rebilling Fee and collection proceedings:

There will be a $10.00 charge added to your balance for each bill after the first two billings (60 days), after which time, your account will be sent to collection. Accordingly, you are responsible for your total account balance, plus an additional charge of forty percent, which will be added to your balance.

Returned Checks:

A $30.00 service charge will be applied to your account for any returned checks.

Canceled or No Show fee for appointment:

There will be a $25.00 fee applied to your account for any appointments broken or canceled without a 24-hour notice.

Thank you for understanding our Financial Policy. We look forward to serving your needs in the future.

Start Treatment Today !

Dental treatment is an excellent investment in an individual's medical and psychological well being. Financial considerations should not be an obstacle to obtaining this important health service. Being sensitive to the fact that people have different needs in fulfilling their financial obligations, we are providing the following payment options.

Payment Options

Financing available through

• No initial payment

• Payment plans up to 60 months with low monthly payments which includes a low fixed rate.

• Additional payment plans are available

• Prepayments can be made anytime without penalty

• Fast, confidential service by phone or on-line at their secure website. Good credit standing required.

Payment in Full

Payment in full is required when treatment begins. For your convenience, we accept the following credit cards:

Also we accept cash or check for in house payment.

*If for any reason the estimated amount is not paid by your insurance company, it becomes your obligation