Family Dentistry Financial Agreement Sample Contracts

Paoli Family Dentistry Financial Agreement
Family Dentistry Financial Agreement • March 15th, 2022

We, the staff of Paoli Family Dentistry, 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 610-647-0353. We believe this level of communication and cooperation will allow us to continue to provide quality service to all of our valued patients.

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Winn Family Dentistry Financial Agreement
Family Dentistry Financial Agreement • May 27th, 2015

This agreement is to inform you of your financial obligation to our practice. We are committed to providing you with the most comprehensive dental care using only the highest quality materials and technology available in the market today. All charges you incur for any treatment that is provided are your responsibility regardless of your insurance coverage. We will always recommend treatment based upon your dental needs, not based on insurance coverage.

Mumm and Kron Family Dentistry Financial Agreement
Family Dentistry Financial Agreement • September 26th, 2021

It is our goal for our patients to understand their treatment needs as well as their financial responsibility before treatment begins. It is our desire to make dental treatment affordable to all our patients. Please review the following policies and procedures:

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