Financial Policies and Agreement Sample Contracts

SUMMER PROGRAM 2022
Financial Policies and Agreement • April 14th, 2022

We realize that the summer can be hard to plan due to last minute vacations, illness, etc so we want to communicate our financial policy. Please let us know if you have any questions.

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Written Financial Policies and Agreement
Financial Policies and Agreement • May 31st, 2021

Thank you for choosing Glowing Smile Dental Studio. Our primary mission is to deliver the best and most comprehensive dental care available. An important part of the mission is making the cost of optimal care as easy and manageable for our patients as possible by offering easy and convenient payment options.

SUMMER PROGRAM 2021
Financial Policies and Agreement • April 15th, 2021

We realize that the summer can be hard to plan due to last minute vacations, illness, etc so we want to communicate our financial policy. Please let us know if you have any questions.

CONVIVIAL DENTAL PC FINANCIAL POLICIES AND AGREEMENT
Financial Policies and Agreement • February 6th, 2024

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 the provider-patient relationship and our goal is not

FINANCIAL POLICIES AND AGREEMENT
Financial Policies and Agreement • June 24th, 2016

CASH PATIENT: All fees for services rendered are due on the time of service. If the patient is in their postoperative period, but has an outstanding balance, payment is still expected before the patients visit. If there is an outstanding balance and payments are not made within 90 days of the visit date, the account will be turned over to the collection agency and collection fees will be added to the account balance; collection fees can be up to 35% of the charge amounts sent to collections. It is the patient’s responsibility to call and update their address.

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