The parent who brings the child in to the dental appointment is responsible for paying the co-payment or full fee. We accept checks Visa MasterCard American Express Discover and Care Credit but we cannot take cash.
20 Dental Payment Plan Agreement Template Simple Template Design How To Plan Dental Simple Business Plan Template
Payment in full all major credit cards cash checks third.
. The following is a statement of Dr. However the IMPORTANT NOTICE that appears on page 1 and again under the heading ATTESTATION BY EMPLOYEE on page 14 should not be altered or reduced in font size. Delinquent Accounts After 90 days all accounts that are not paid in full may be sent to a third party collection agency.
We are committed to providing you with the highest quality lifetime dental care so that you may attain optimum oral health. Please understand that payment of your bill is considered as part of your treatment. If it is necessary we are happy to hold a creditdebit number from the non custodial parent on file.
Use my download here as a template. Patient Treatment and Financial Policy Thank you for choosing our office as your dental healthcare provider. We offer a 5 discount for all treatment over 2000 paid in cash or check.
Are you tired of chasing co-pays. We accept cash personal checks debit card money orders Visa Mastercard and Discover. January 2019 This is a sample manual.
Patient payment agreement form. Outside financing is available through Care Credit upon request and approval. The dental financial agreement works best with options.
We reserve the right to charge a 3500 fee on all returned checks. This form explains to all of our patients the billing process only of the office -- much like a payment agreement for a credit card or billing policies and procedures for utility companies. This valuable ADA resource comes complete with nearly 100 sample dental office policies as well as definitions of key HR terms and even samples of dental job applications.
In addition we offer CareCredit a patient payment program offering a full range of No Interest and Extended Payment Plans for treatment fees from 1 and up. Therefore if you have any questions or concerns about our payment policies please do not hesitate to contact our office staff. Regarding Insurance Our goal is to maximize your insurance benefits.
We ask that all patients read and sign our financial policy. The dental financial policy template letters of importance summit will provide comprehensive periodontal services. Payment plans and financial arrangements are available for comprehensive dental treatment.
Additions deletions or changes should be made to reflect the policies and practices in your office. Do you have a transparent patient payment agreement signed by each of your patients. We ask that you please read agree to and sign before any treatment is rendered.
All patients with balances over 50000 will be asked to sign a Financial Arrangements form indicating the entire cost of their treatment estimated insurance finance charges and payment schedule. This is an insurance company policy. Our main concern is that you receive the proper and optimal treatment needed to restore and maintain your dental health.
Its template format provides a straightforward easy-to-understand approach that can streamline the process of developing key policies and procedures. Insurances vary in their coverage and it is the patients responsibility to understand hisher dental benefits. DENTAL OFFICE EMPLOYEE MANUAL Revised.
In order to achieve this we need your assistance and your understanding of our financial policy. 308 Main Street Oneida New York 13421 315 363-4850 OFFICE FINANCIAL POLICY YOUR DENTAL BENEFITS We would like our patients to be informed of our financial policy. In order that we may have a definite understanding in regard to the payment for dental services the following is our policy.
Heres the form for you. We are committed to providing you with the best possible care. The following is our Financial Policy.
The following is a statement of our Financial Policy which we require that you read agree to and sign prior. If you will allow them accountable and dental financial policy template yours financial policy to them to be remedied thi office and stay even if no. Financial Policies - Aspen Dental.
The following is a statement of our Financial Agreement which we require you to read and sign prior to any treatment. We accept the following forms of payment. Many times a simple telephone call will clear any misunderstandings.
Are you providing transparency in your dental practice. Cash Check Visa and MasterCard. All office co-payments are to be paid at the time of service.
Everyone benefits when office and financial policy arrangements are understood. You must qualify to use this nancing option. Should fees increase at any time the office will honor treatment plans for dental treatment up to four months from diagnosis.
If a patient has dental insurance coverage we will expedite the submission of your insurance forms for early. Payment is due at the time service is provided. For the answers to any other questions you have please refer to our Dental Office Information and Policies brochure available at the office and or.
Financial Policy and Payment Options for Fort Lee NJ Dentist Dr. Any accounts turned over to collections will be assessed a collection fee of 33. 403-254-4509 Office policies and Financial Agreement It is our desire to provide the highest quality dental care to everyone.
All groups and messages. Please contact us at Fort Lee Office Phone Number 201-224-9000. As a place to start to design your own treatment acceptance form.
Find out More about Care Credit Here.
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