We are pleased to welcome you to our practice. Our desire is to provide you with the highest quality dental care to educate your family, and to create caring relationships in a compassionate, child friendly atmosphere. It is our policy to make definite financial arrangements with you before any treatment starts. Below is an explanation of our payment procedures. If you have any questions, please do not hesitate to ask.

1. Payment for services are due at the time service is rendered. We accept cash, checks, and credit cards; Visa and MasterCard.

2. As a courtesy, we will provide you with a copy of the charges to submit to your insurance carrier for your reimbursement or you may assign the payment to our office and we will file the insurance for you.

3. You must provide the office with a dental (not medical) insurance card with the proper mailing address of the insurance company, or provide a dental (not medical) claim form, which is provided by the employer. If one of these documents is not available at the time of the appointment, you will be responsible for payment & all fees and we will provide you with a claim form for you to submit for reimbursement.

4. If insurance benefits are assigned to the doctor, you will be responsible for paying your deductible and co-payments at the time of service. You are responsible for paying all changes not covered by your insurance company, including all fares considered above your insurance company's usual and customary fee schedule.

5. Your insurance benefits are a contract between you and your employer. The amount of coverage you will receive will depend on the quality of the plan purchased by your employer, not the fees of the doctor.

6. The office can not carry balances longer than 90 days, regardless of insurance payment.

7. A $5.00 monthly re-billing charge will be added to your account if it is not paid within 90 days, regardless of balance amount.

8. After 90 days, we will inform you of the delinquent account by letter and if no action is taken to clear the account, this office will be required to employ a collection agency to collect the payment.

9. There will be a $25.00 service charge for all returned checks.

10. The parent or guardian who brings the child for their initial visit is responsible for payment independent of what a divorce doctrine may state. Reimbursement must be made between the divorced parents. We will not intervene.