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Willow Point Dental P.C.

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Appointment Policy

Our office makes every attempt to remain on schedule throughout the day. We value your time and will do our best to keep you from having to wait. Our office reserves appointments for patients according to their needs. Each person is an individual, and some may require more "tender loving care" than others. We ask for your patience, and that you keep in mind that you may be the next one needing our extra attention.
As a courtesy, our office will attempt to contact you for confirmation 1-2 days before your appointment. However, we do ask that our patients/parents assume responsibility for your appointment time. Broken appointments or cancellations without proper notification can be costly to our office and unfair to other patients who need appointments. In recent years we have seen an increase in cancellations and broken appointments; due to this increase, our office will require a minimum of $25.00 deposit to reserve an appointment for any and all future treatments. At the time of your appointment, this deposit will be applied to your treatment or rolled over to your next scheduled appointment. However, if you fail to keep the appointment or cancel without a 24 hour notice, the deposit will be forfeited.

Insurance Policy

Insurance policies vary greatly and we can only estimate your coverage. We are committed to helping you maximize your dental benefits. Your estimated portion is expected at the time of service. As a courtesy to our patients, we will bill your insurance company and allow them 45 days to render payment. After 60 days, you will be responsible for the balance as well as following up with your insurance company regarding payment.

If you don't pay the entire new balance within 14 days of the monthly billing date, a service charge will be added to the account for the current monthly billing period. The service charge will be a periodic rate of 1.5% per months (or a minimum charge of $2.00 for a balance under $125.00) which is an annual percentage rate of 18% applied to the last month's balance. In the case of default of payment, you promise to pay any legal interest on the balance due, together with any collection costs and reasonable attorney fees incurred to effect collection of this account.

* I have read and understand the above policies.

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(Your digital signature (full name) is as legally binding as a physical signature.)