top of page
Download & Fill Out Our Patient Registration Form
As a courtesy we will gladly file your claims and accept assignment of dental insurance benefits provided you agree to the following:
Although we may estimate your insurance benefits, we are not responsible for their accuracy. Knowledge of benefits as well as benefit amounts, limitations, exclusions, waiting periods, etc. is entirely your responsibility. Receiving our services indicates your acceptance of responsibility to pay regardless of our estimate.
All charges not paid by your insurance are your responsibility regardless of the reason for nonpayment. Not all the services we provide are covered benefits. Benefits differ from one company to another. Fees for non-covered services, along with deductibles and co-payments, are due at the time of treatment unless other payment arrangements have been made.
bottom of page