Your treatment plan will include a breakdown of all applicable
fees, and we will inform you of all costs before treatment is
administered. Charges are payable at the time of treatment.
Additionally,
we will submit all insurance claims for you. We will fully
attempt to help you receive full insurance benefits; however,
you are personally responsible for your account, and we encourage
you to contact us if your policy has not paid within 30 days.
Download Forms
1.
Pediatric Dentistry Informed Consent for Patient Managemetn
Techniques and Acknowledgement of Receipt of Information (Download)
2.
Pediatric
Dentistry Consent for Dental procedure and acknowledgment
of receipt of information.
(Download Page1, Page2)
3.
Consent for the use of sedation for pediatric dental treatment
and acknowledgment of receipt of information
(Download)
4.
Treatment Authorization (Download)
5-Agreement
for Billina Absent Parent (Download)
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