Financial Responsibility Agreement and Consent for ServicesFinancial Responsibility Agreement and Consent for Services • March 12th, 2013
Thank you for choosing our practice to serve your dental needs. We appreciate the confidence you have placed in us and will do everything possible to warrant your continued confidence. In order to provide quality service and care to our patients, we ask that you please read and agree to our office policy.
Financial Responsibility Agreement and Consent for ServicesFinancial Responsibility Agreement and Consent for Services • July 1st, 2022
Dental insurance is designed to help offset the cost of dental care. Insurance estimates provide a table of allowances that will assist you in determining your approximate out-of-pocket expenses.
Financial Responsibility Agreement and Consent for ServicesFinancial Responsibility Agreement and Consent for Services • June 13th, 2019
Thank you for choosing our team of dental professionals to serve your dental needs. We are committed to providing you with the highest quality care. We appreciate the confidence you have placed in us and will do everything possible to continue to warrant your confidence as we serve you. In order to continue providing outstanding care to all of our patients, we ask that you please understand and agree to the following office financial policy.
Financial Responsibility Agreement and Consent for ServicesFinancial Responsibility Agreement and Consent for Services • May 27th, 2022
Thank you for choosing our team of dental professionals to serve your dental needs. We are committed to providing you with the highest quality care. We appreciate the confidence you have placed in us and will do everything possible to continue to warrant your confidence as we serve you. In order to continue providing outstanding care to all of our patients, we ask that you please understand and agree to the following office financial policy.
Financial Responsibility Agreement and Consent for ServicesFinancial Responsibility Agreement and Consent for Services • February 12th, 2010
Thank you for choosing our team of dental professionals to serve your dental needs. We are committed to providing you with the highest quality care. We appreciate the confidence you have placed in us and will do everything possible to continue to warrant your confidence as we serve you. In order to continue providing outstanding care to all of our patients, we ask that you please understand and agree to the following office financial policy.
