PROFESSIONAL TEETH WHITENING FOR LIFE!

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1 HOUR IN-OFFICE WHITENING AVALIABLE!!
$299.00

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STRAIGHT TEETH IN 6-7 MONTHS!!!!

CARIES ID DETECTION SYSTEM

CANCER DETECTION SYSTEM

Thank you for choosing our office for your dental needs. We realize that every person's financial situation is different. For this reason, we have worked hard to provide a varietyof payment options to help you receive the dental care you need and deserve that allows you to enjoy a healthy, beautiful smile with respect to your budget. We are always available to answer your questions or assist you in any way we can.

To maintain the practice operations and to prevent potential misunderstandings, we ask patients to accept and adhere to financial arrangements regarding their dental treatment. Payments are expected at the time services are rendered. We accept cash,checks* and all major credit cards.

As a condition of your treatment by this office, financial arrangements must be made in advance. The practice depends upon reimbursement from the patients as well as from their insurance providers for the costs incurred in their care and financial responsibility on the part of each patient must be determined before treatment.

All Emergency dental services, or any dental services performed without previous financial arrangements, must be paid for in cash at the time of services are performed.

If you have dental insurance you are responsible for all fees and estimated co-pays and the difference between actual benefit plan payment and the PDP fee for services provided. This payment is expected at the time of service based on the estimate of your dental plan benefits.

If you wish us to file insurance claim for you - Social Security # and copy of your Drivers License will make the procedure much more efficient.

Optional Payment Terms:

1. Cash, checks* or Credit Card Payment for Entire Treatment Plan:
- Total treatment plan : $500-$1500 = 5% discount
- Total Treatment Plan: $1500 and over= 10% discount.

2. Pay As You Go for Each Treatment: Total Paid at Time of Treatment
- 5% Discount when paid by Cash or Checks*
- 0% Discount when paid by Credit Card

3. Major Service Payment Option: We offer a two-payment option for Crown, Bridge, and Denture treatment. We ask you to pay ½ of portion at the first appointment and second half at the delivery date appointment.

4. Payment Over Several Months By arrangement with Care Credit, we offer our patients, upon approval, an interest- free term loan (up to 6 months) with no down payment, no annual fee, and no prepayment penalty. Please ask for an application.

DOCTOR PAYS THE INTEREST!

A service charge of 1.5% per month on the unpaid balance will be charged on all accounts exceeding 60 days unless previously written financial arrangements are satisfied.

Broken appointments: This time that has been reserved especially for you and we
strongly encourage all patients to keep their appointments. If you must change your
appointment, we require at least 24 hours notice to avoid a $70.00 cancellation fee
(emergencies are an exception).

*option for established patients only