Dental Office Financial Agreement Sample Contracts

DENTAL OFFICE FINANCIAL AGREEMENT
Dental Office Financial Agreement • January 22nd, 2020

Thank you for choosing us as your dental care provider. We are committed to your treatment being successful. Please understand that payment of your bill is considered part of your treatment. The following is a statement of our financial policy which we require that you read and sign prior to any treatment.

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DENTAL OFFICE FINANCIAL AGREEMENT - Eva Balogh D.M.D.
Dental Office Financial Agreement • June 16th, 2024

Thank you for choosing us as your dental care provider. We are committed to your treatment being successful. The following is a statement of our financial policy which we require that you read and sign prior to any treatment.

DENTAL OFFICE FINANCIAL AGREEMENT
Dental Office Financial Agreement • February 3rd, 2022

Thank you for choosing Sutton Dentistry as your dental care provider. We are committed to your treatment being successful. The following is a statement of our financial policy which we require that you read and sign prior to any treatment.

DENTAL OFFICE FINANCIAL AGREEMENT
Dental Office Financial Agreement • April 24th, 2024

Thank you for choosing ZCYW as your dental care provider. We are committed to your treatment being successful. Please understand that payment of your bill is considered part of your treatment. The

DENTAL OFFICE FINANCIAL AGREEMENT
Dental Office Financial Agreement • February 26th, 2015

Thank you for choosing us as your dental care provider. We are committed to your treatment being successful. Please understand that payment of your bill is considered part of your treatment. The following is a statement of our financial policy which we require that you read and sign prior to any treatment.

DENTAL OFFICE FINANCIAL AGREEMENT
Dental Office Financial Agreement • April 20th, 2022

Thank you for choosing us as your dental care provider. We are committed to your treatment being successful. Please understand that payment of your bill is considered part of your treatment. The following is a statement of our financial policy which we require that you read and sign prior to any treatment.

DENTAL OFFICE FINANCIAL AGREEMENT
Dental Office Financial Agreement • June 25th, 2018

Thank you for choosing us as your dental care provider. We are committed to your treatment being successful. Please understand that payment of your bill is considered part of your treatment. The following is a statement of our financial policy which we require that you read and sign prior to any treatment.

Dental Office Financial Agreement
Dental Office Financial Agreement • March 24th, 2022

Thank you for choosing us as your dental care provider. We are committed to your treatment being successful. Please understand that payment of your bill is considered part of your treatment. The following is a statement of our financial policy which we require that you read and sign prior to any treatment.

DENTAL OFFICE FINANCIAL AGREEMENT
Dental Office Financial Agreement • May 25th, 2022

Thank you for choosing Grandville Family Dental Care as your dental care provider. We are committed to providing you with the best possible dental care and we would like you to review and sign our financial policy below before your treatment begins. Discussions regarding money are not always easy and we feel this policy will help everyone to understand our financial arrangements. Thank you.

DENTAL OFFICE FINANCIAL AGREEMENT
Dental Office Financial Agreement • February 7th, 2023

Thank you for choosing our office for your dental care. We are committed to your treatment being successful. Please understand that payment of your bill is considered as part of your treatment. The following is a statement of our financial policy which we require that you read and sign prior to any treatment.

DENTAL OFFICE FINANCIAL AGREEMENT
Dental Office Financial Agreement • September 15th, 2022

Thank you for choosing us as your dental care provider. We are committed to your treatment being successful. Please understand that payment of your bill is considered part of your treatment. The following is a statement of our financial policy which we require that you read and sign prior to any treatment.

DENTAL OFFICE FINANCIAL AGREEMENT
Dental Office Financial Agreement • July 25th, 2023

Thank you for choosing us as your dental care provider. We are committed to your treatment being successful. Please understand that payment of your bill is considered part of your treatment. The following is a statement of our financial policy which we require that you read and sign prior to any treatment.

DENTAL OFFICE FINANCIAL AGREEMENT
Dental Office Financial Agreement • July 28th, 2023

Thank you for choosing Maple Lawn Family Dentistry as your dental care provider. We are committed to your treatment being successful. Please understand that payment of your bill is considered part of your treatment. The following is a statement of our financial policy which we require that you read and sign prior to any treatment.

DENTAL OFFICE FINANCIAL AGREEMENT
Dental Office Financial Agreement • June 17th, 2020

Thank you for choosing us as your dental care provider. We are committed to your treatment being successful. Please understand that payment of your bill is considered part of your treatment. The following is a statement of our financial policy which we require that you read and sign prior to any treatment.

DENTAL OFFICE FINANCIAL AGREEMENT
Dental Office Financial Agreement • February 3rd, 2022

Thank you for choosing Lawrence J. Sutton, D.D.S. P.A. as your dental care provider. We are committed to your treatment being successful. The following is a statement of our financial policy which we require that you read and sign prior to any treatment.

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