Kiesel Dental Financial AgreementDental Financial Agreement • January 28th, 2016
We, the staff of Kiesel Dental Associates, thank you for choosing us as your dental provider. We consider it a privilege to serve your needs and we look forward to doing so. We are committed to providing you with the highest level of care and to building a successful provider-patient relationship with you and your family. We believe your understanding of our patients’ financial responsibility is vital to that provider-patient relationship, and our goal is to not only inform you of the provisional aspects of that financial policy but also to keep the lines of communication open regarding them. If at any time you have any questions or concerns regarding our fees, policies, or responsibilities, please feel free to contact our Office Manager at 215-536-1717.
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WEST 85TH DENTAL FINANCIAL AGREEMENTDental Financial Agreement • August 27th, 2020
Due to recent legislation, you are covered under the privacy act; your information through your insurance provider is confidential and therefore will not be release to our office. We urge YOU to become familiar with any dental benefits you may have. The office will not be pre-determining your basic dentistry. If you or your insurance company requires pre-authorization, we will be happy to provide you with the information, with the results only coming directly to you. Ultimately if there is a problem with your insurance, it is your responsibility.
