Financial Information

Payment For Services:

We deliver the finest care at the most reasonable cost to our patients; therefore, payment is due at the time service is rendered unless other arrangements have been made in advance.  For your convenience, we accept cash, check, Visa, Mastercard, American Express, Discover, CareCredit and Sunbit. Please note: Mastercard, Visa, Discover and American Express credit cards will be charged a 3% convenience fee that will be added to your payment. This fee does not apply to cash, check, HSA/FSA cards, or debit cards.  There will be a $25 charge for all returned checks.

For single tooth extractions, we do require payment in full at the time of service.  After payment, we will provide you with a completed claim form to send to your insurance company for reimbursement.  For all other procedures, we will be happy to provide an estimate of insurance coverage to you.  You will be responsible for your copay at the time of service.  Please remember you are fully responsible for all fees charged by our office regardless of insurance coverage. The signature below will be used as authorization for the release of information necessary to process your insurance claim.  Your signature also authorizes payment directly to our office of the insurance benefits otherwise payable to you.

Statements:

We will send you a monthly statement.  Most insurance companies will respond in four to six weeks.  Any remaining balance after your insurance has paid is your responsibility regardless of our estimated coverage amount given to you prior to your procedure. Your prompt payment is appreciated.  Accounts outstanding more than 60 days from treatment will bear interest at 1.5% per month.

Financially Responsible Party Information:

If you are 18 years of age and over, you are your own financially responsible party.

If someone other than yourself has power of attorney to make decisions on your behalf, they may be listed as financially responsible. (legal document required)

For children under the age of 18, the parent who accompanies the child to the appointment will be listed as financially responsible for the child regardless of who holds the insurance.

Payment Plans:

At your consultation appointment, it will be determined if we can offer a payment plan to you.   Payment plans are based on a credit evaluation. Patients 18-26 years of age, who are full time-students wishing to use their parent or legal guardian’s credit to qualify for a payment plan may do so with the parent’s signed permission.

Collections:

Failure to pay all charges under this agreement will result in additional collection agency/court fees which typically range from 33-50%

Credit Card Processing Fee Notice
Beginning April 9, 2026,  a 3% processing fee will be applied to all payments made by credit card.