1. Payment is due at the time of service. Payment may be made in cash, Master Card, Visa or Discover. If a check is returned to us because of insufficient funds, you will be assessed a $50 return check charge.

2. Insurance: It is your responsibility to understand your particular insurance contract. Due to specific exclusions and restrictions that may be placed on your plan, some of the services we provided may not be a covered benefit. The insurance contract is between you, your employer, and the insurance company. We are not a party to this contract. It is your responsibility to find out your insurance plan specifics. As a courtesy to you, we will be happy to submit to your insurance company for services, so that you will not have to outlay your own funds.

3. If you are a divorced-single parent bringing your child in for treatment, you are the responsible party to this office for all payments. Any legal agreement that someone other than you is responsible for dental costs must be dealt with outside this office. Our agreement/contract is with the parent who is bringing the child in for treatment.

4. If you are the parent of teenage children who will be coming for appointments on their own, we ask that you send the appropriate payment for the service they will receive that day.

5. If there is a balance remaining after you have paid your estimated co payment on the date of service and we have received all insurance monies on your account you will receive a notice of payment due from this office. Payment of this balance is expected within 30 days. If payment is not received in a timely manner, your account will be referred for collection.