Patient Information

Appointment Confirmation

Our office will generally call, text, or e mail 24 to 48 hours prior to your appointment to confirm your visit. However, it is your responsibility to remember your appointment to avoid any cancellations fees.

Cancellation Policy

If you are unable to keep your appointment time, you must notify our office 48 hours in advance to avoid any cancellation fees. If a patient does not show up, arrives late or cancels their appointment without 24 hours notice, a fee of $40.00 per half hour of scheduled appointment time will be charged to the patient (this fee is subject to change without prior notice).


Emergency time is available during our regular scheduled office hours, and the doctor can be reached on weekends for your emergency needs. If a patient is unable to meet the appointment time they are offered, then, they will be given the next available appointment time.

Copy of Records

We will gladly provide you with a copy of your dental records, and or X-rays. Please note that the state requires us to keep the original records on file. Therefore, to cover our costs in duplicating documents, there is a nominal fee of $25.00 per chart. Under the IDP AA Privacy Act, the patient must be present and sign paperwork to release such records. Any unpaid balance for services must be paid prior to the release of such records.

Insured Patients

We will gladly submit your dental claim for you. We can only submit the same claim a maximum of two times. If an insurance company has not paid a claim after a 45 day period, the entire balance is then the patient's responsibility. Adjustments will be made after the patient has settled the claim with their insurance company. It is the patient's responsibility to know their dental coverage. Your portion of payment will be due the day the treatment is rendered. A bill will be sent if there is a balance after insurance payments and or adjustments have been made. It is always the patients responsibility to clear any balance not paid by the insurance company.

PLEASE NOTE: In the event of benefit denial, it is not the responsibility of our office to appeal the claim. However, you have the right to personally appeal the rejected claim.

Un-insured Patients

Patients without dental insurance are required to make a payment at the end of their visit. Any financial concerns should be discussed prior to your appointment.

Past Due Accounts

An interest rate of 2% per month will be assessed to all unpaid balances after the due date on the statement. Statements that have carried over the 30 day billing cycle will be subject to collection agency review. Any costs that arise or accrue from being in a collection account or legal review will be the patients' responsibility.

Patient Forms

 Welcome To Our Practice


Credit Card on File Policy