Office Info/Forms/Finances


When you are on time, it helps us be on time! But we also realize there will be times when you arrive late to your appointment. When that happens, we will make every effort to see your child based on our schedule. However, every family has an appointment reserved for them - just like you. So in some instances we may need to reschedule your appointment to be fair to other families who have arrived on time.

When a conflict arises and you must reschedule your appointment with us, we ask for the courtesy of 48 hours notice. Please be aware there is a fee for a missed or late-cancel appointment when we do not receive 24 hours notice. We do try to provide you with a courtesy call to remind you of your child’s appointment. However the responsibility of remembering your appointment is still yours regardless of whether or not we are able to reach you with a reminder call.
Please call us if your plans change. THANK YOU!

Please print and fill out these forms and bring them to the office.

Our practice is a fee-for-service pediatric dental practice. Most insurance companies only pay a portion of the fees incurred. We require that your balance for each procedure be paid at the time of treatment. We do work with most kinds of private dental insurances as well as Delta Dental and work with them to maximize your insurance reimbursement for covered procedures. If you do not have dental insurance, payment of all dental fees are expected to be made at the time services are rendered.

Please remember to bring your insurance information with you. Although we will always try to assist you with insurance issues, it is your responsibility to understand your insurance policy and interact accordingly with your insurance provider.

For your convenience, we accept personal checks, MasterCard, Visa, and America Express. While we can not assume responsibility for payments by the insurance carrier, we will be happy to assist you with any communications with the company. Upon request, prior to treatment, we can give you an estimate of what your insurance may pay and an estimate of your portion; you will be expected to pay your portion at each visit. Note that dental insurance rarely covers 100% of dental fees. When insurance payment is not received after 60 days, the insurance balance becomes your responsibility. In all cases, including divorce, the adult who brings the child to their dental appointment is responsible for payment at the time care and treatment is provided.

If your child requires treatment in a hospital setting, we will ask you for your medical insurance information. While we do not bill the medical insurance, the hospital and anesthesiologist usually require preauthorization prior to scheduling.