Dental Expressions Financial Disclosure

Thank you for choosing our offices for your dental needs.  We appreciate your trust in us, and the opportunity to serve you.  As part of our services to you, and in effort to contain costs, we have implemented the following financial policy.  Please familiarize yourself with the enclosed and sign the disclosure.  If you have any questions please feel free to ask our business associates at our front desks.  Thank you.


1)  All patients are responsible for all services rendered.  This is to be taken care of at time of service, unless financial arrangements have been made prior to treatment with our financial coordinators.

2)  Outside financing is available for any amount over $1000.00 through CareCredit.  Please see our financial personnel for details.

3)  Patients can recieve a discount if payment is recieved on the day of service. (non-financing)  See our financial personnel for details.

4)  As a courtesy, we will file insurance claims for you; however, your estimated portion is expected at time of service.

Notes:  Accounts over 60 old can be subject to finance fees.  And finally, any patients under the age of 18 must be accompanied by a guardian unless otherwise discussed with dental personnel.

 

Signature: _______________________________    Date:_______________________