Office Financial Agreement

Thank you for choosing us as your dental care provider. We are committed to your treatment being successful. Please understand that payment of your bill is considered part of your treatment. The following is a statement of our financial policy which we require that you read and sign prior to any treatment.

General: Understand that regardless of any insurance status, you are responsible for the balance due on your account. You are responsible for any and all professional services rendered. This includes but is not limited to: dental fees, surgical procedures, tests, office procedures, medications, lab expenses, dental cleanings, and also any other services not directly provided by the dentist. 

Our Promise: We will always make it clear what each procedure will cost and what you will owe at each appointment. 

Insurance: Please remember your insurance policy is a contract between you and your insurance company. We are not a party to that contract. As a courtesy to you, our office provides certain services, including a pre-treatment estimate which we send to the insurance company at your request. It is up to you to contact your insurance company and inquire as to what benefits you have. If you have any questions concerning the pre-treatment estimate and/or out-of-pocket expenses, it is your responsibility to have these answered prior to treatment to minimize any confusion on your behalf. Please be aware some or perhaps all of the services provided may or may not be covered by your insurance policy. Any balance is your responsibility whether or not your insurance company pays any portion.

Please note that although we accept most dental insurances, we are only “In Network” with Delta Dental Premier. That means that for most dental insurance plans there may be an “out-of-pocket” portion for each procedure and/or treatment plan. It is your responsibility to inquire about what the cost breakdown may be.

Payment Methods: We accept payment via dental insurance, Visa, Mastercard, Discover, American Express, check and cash. Patients can also pay online at We also accept financing via Care Credit.

Payment: FULL PAYMENT is due at the time of service unless a financial agreement or payment plan has been made otherwise. If insurance benefits apply, ESTIMATED PATIENT CO-PAYMENTS and DEDUCTIBLES are due at the time of service, unless other arrangements are made. If payment is delinquent, the patient will be responsible for payment of collection, attorney’s fees, and court costs associated with the recovery of the monies due on the account

We accept the following dental insurances and others