Dental office financial agreement thank you for choosing us as your dental care provider. Practices using dentalbanc often offer us as their only option for office payment plans.
Financial policy and agreement.
Dental office dental payment plan agreement template. Our fees reflect our professional commitment to excellence. The patient will be notified and the patient will be responsible for payment to the dental office and collecting the money from their insurance company. However we understand that occasionally patients may need to make a temporary payment agreement while receiving necessary chiropractic care.
Option four pre treatment payment plan i would like to budget my treatment by making monthly payments to the dental practice to be applied toward future treatment. In order to achieve these goals we need your assistance and understanding of our payment policy. Payment is due at time of service unless other arrangements of been made prior to the reserved appointment.
An explanation of the recommended treatment and the estimate of fees involved will be presented to you for acceptance. Access all of the downloadable dental forms offered on diq in one convenient location. 4 payment may be divided into two equal payments for our patients of record one half to be paid on the day treatment begins the remaining half to be paid when treatment is completed.
Timely treatment plan. 5 comfortable monthly payments may be made through our billing office 90days only. I accept option to pay for my dental treatment.
We are committed to your treatment being successful. Meyer this form explains to all of our patients the billing process only of the office much like a payment agreement for a credit card or billing policies and procedures for utility companies. Patient payment agreement we are committed to providing you with the best possible dental care.
Treatment is recommended based on what you need not on what is covered by your plan. We welcome and encourage a frank discussion of your financial investment in your dental health. Payment in full is due at the time of.
Dentalbanc provides dental payment plan drafting and management. Dentalbanc is a great alternative to 3rd party financing. Please understand that payment of your bill is considered part of your treatment.
I understand that with this payment option and the delay of treatment it could result in health risks additional dental procedures and increased fees. For the answers to any other questions. If you qualify a monthly payment plan.
This article originally appeared in dental assisting office manager digestsubscribe to the monthly e newsletter here. The following is a statement of our financial policy which we require that. We offer the following methods of payment of fees.
Financial policy for the dental office of dr. My docformspatient payment agreement112907 patient payment agreement burlington family chiropractic it is our preferred office policy that payment is due at the time of service. Do you have a transparent patient payment agreement signed by each of your patients.
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