Dentistry Unlimited Office Policies

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Dentistry Unlimited Office Policies
Welcome to our practice. In our continuing efforts to provide comprehensive dental care to you, our valued patients, we ask that you become acquainted with our office policies. If at any time you have any questions, please feel free to ask so that we may better serve you. All recommended treatments are in the best interest to our patients. We will inform you of the fees before we perform all procedures. Please note that no two mouths are alike; therefore, we will customize treatment to suit your individual needs.

Dental Insurance

We will submit all insurance forms as a courtesy to our patients, provided that the information necessary is given to us. Please note that your dental insurance is a contract between you and the insurance company, not between your dentist and the insurance company. Our usual and customary fees are a reflection of our commitment to excellence, which is modest with the geographical area. If for any reason your insurance company fails to pay for services rendered, you are responsible for all payments. All estimated co-payments and deductibles are due when service is rendered, unless prior payment arrangements have been made.

Preferred Method of Payment

In an effort to keep dental costs down while maintaining a high level of professional care, we have established the following payment options that are available to our patients. We accept personal checks, cash, debit, and all major credit cards. There will be a ten dollar ($10.00) returned check fee applied to your account in the event that the bank denies your check. Payments must be paid within 48 hours of notice from the bank by cash or money order. Payment plans are available for large treatment plans. Extended payment plans are available through our partner, CARE CREDIT, which offers a wide range of flexible plans, including no-interest plans. Enrollment is easy and can be done in-office or online in the privacy of your home. For more information, visit Please ask a front desk representative for more information.

Payment Agreement

There will be a finance charge of 1.25% per month on all balances forty-five days or older. A billing charge of $5.00 per month will also be charged for all balances that have not been paid after each visit, and are not set up on a payment plan. In event that there is a default of payment on any amount due, and your account is placed in the hands of an attorney or collection agency, you will be charged an extra fee equal to the processing fee as well as any collection agency/attorney fees.

General Appointments

We reserved appointment time especially for you and your specific dental needs. When you cancel on short notice, other patients that needed treatment cannot be seen and that time is wasted. Therefore, we ask for your consideration and that you kindly give us a 24-hour notice if you are unable to keep your appointments. A fifty dollar ($50.00) broken appointment fee will be charged to your dental account if 24-hour notice is not given. You may leave a message on our office voice mail if an event comes up after hours and you are unable to make an upcoming appointment. Please note that if proper notice is given, or a real emergency takes place the fifty-dollar ($50.00) broken appointment fee may be waived.
Emergency Care

If you have a dental emergency after hours on a week night, call your doctor at home. If you have a dental emergency any time Friday after noon, call our phone number and leave a message at the emergency prompt. The doctor on call will be paged, and your phone call will be returned.

Office Hours
Monday 7:00 am – 7:30 pm

Tuesday 7:00 am – 6:00 pm

Wednesday 7:00 am – 6:00 pm

Thursday 7:00 am – 6:00 pm

Friday 7:00 am – 12:00 noon
I have read and understand the office policies written above.

Signature Date

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