Welcome to our practice! We are delighted that you have chosen our practice to serve you and your family’s dental needs. Please be aware of some of our office policies. Thank you.
FIRST APPOINTMENT
Your FIRST appointment will include Xrays and a full examination only. If you have recent xrays we will call your previous dental office and ask them to be transferred. The dental cleaning (Prophy) portion of your new patient visit will be done at a second visit. Please complete the new patient forms from this site and either fax or email them to us, or bring them in with you to your appointment.
MISSED APPOINTMENTS
Broken and missed appointments are very costly to our practice and cause delayed treatment for all of our patients. There is a Broken Appointment charge of $45 for any appointment canceled without 24 hours notice. For major treatment appointments - including crowns, veneers, root canals, complete or partial dentures, and periodontal visits - we request a 48-hour notice. Cancellation calls are only accepted during our normal business hours.
If necessary, please ask for more information regarding this policy.
Financial Policy
We understand that the financial aspects of dental procedures can often be confusing. We hope that these guidelines will help to clarify any financial obligations concerning the procedures performed in this office.
Payments Accepted
We accept Visa, Master Card, Discover, American Express, as well as cash or personal checks.
Minor Procedures
Some insurance policies cover certain procedures in full. In the event that your insurance company does not pay in full, your payment is due at the time of service. There is a $10.00 billing fee for any deductible or coinsurance amounts not made on the day of service.
Major Procedures
Any service requiring multiple visits or lengthy appointments - including crowns, veneers, root canals, complete or partial dentures and periodontal visits - requires a $100 deposit prior to scheduling. Also, payment of any “patient balance” is required at the first appointment. The “patient balance” is the portion of the bill that is not covered by insurance. Please, we ask that any change you may request to this policy be discussed PRIOR to the service being performed.
Dental Insurance
Full dental insurance information is necessary in order to bill your insurance company. Incomplete insurance information will require us to ask for full payment at your visit.
Pre-Determination
We require a pre-determination of your dental benefits prior to the beginning of any major procedure. This process helps to clarify what the insurance company will pay for a specific procedure and what your patient balance will be. We will send in a pre-determination form to your insurance company on your behalf. A pre-determination IS NOT a guarantee of payment, but is often the closest to a guarantee that we can get from an insurance company.
Finance Options for Major Procedures
We can help arrange financing for major dental procedures. All financial arrangements must be made prior to our services being performed.
Please ask us about the CARE CREDIT financing option we have available.
We do not offer in-office financing.
Any remaining balance on your account is your responsibility and by signing below, you agree to pay any and all collection agency fees and/or attorney’s fees required in the event of a collection action.
Any remaining balance on your account after sixty (60) days will incur interest of 1% per month. Additional interest and billing fees are added in the event the account is turned over to a collection agency.
We encourage you to ask any questions you may have regarding our office and financial policies. We look forward to seeing you and assisting you and your family with your dental care.
If you have any questions please contact our office prior to any visit or procedure. Thank you for choosing Westside Family Dental!