• Financial Policy and Agreement

  • Diagnostic & Consultation Services

    All Fees are due at the completion of your diagnostic appointment (today). If you have questions about the amount due today, please ask the receptionist. A treatment plan will be created with estimated costs shown for any future appointments.
  • Insurance Payments

    If you have insurance coverage, we will file the necessary paperwork with your insurance carrier, based on the information you provide for us. We will credit your account with the insurance payment amount when it is received. This is a courtesy offered to our patients, we accept no responsibility or liability due to denied claims, exceeded maximums, or denials due to insurance plan/policy limitations or plan/policy guidelines. You are fully responsible for knowing your own insurance coverage limitations and are liable for any charges incurred because of services rendered regardless of how your insurance pays. You are responsible for knowing what your out of pocket portion will be at the time of treatment. All coverages, co-pays, deductibles and/or amounts due are estimates only.
  • General Payment Terms

    100% of the fee is due at the time of service if the overall treatment cost is $500 or less. If the fee is more than $500 then payment arrangements may be made, please speak to our Financial coordinator for your payment options.
    We accept Checks, Cash, and all major credit cards. Payment plans are available through Care Credit or Compassionate Finance upon approval.
    Our office does offer 5% discounts for NON-insured Students, Seniors, and those making cash payments at the time of service. A 3% discount is also offered for those paying in full with a credit card. Discounts are not cumulative.Maximum allowable discount is 5%.
  • Scheduling and Cancellation Policy

    Town creek Family Dentistry is dedicated to your quality care and is pleased to reserve your appointment time exclusively for you. We attempt to schedule appointments that are most convenient for you and that fit your personal schedule. We respect our patients time and make every effort to remain on schedule. We understand delays can happen. However, if you know you’ll be more than 10 minutes late, we may have to reschedule. Some visits are more complicated than initially anticipated, and emergencies may arise that could possible delay us. In such a case, every effort will be made to notify you beforehand. Because we reserve time exclusively for each patient, we ask that you make every effort to not change your reserved dental appointment. If you find that you cannot keep your scheduled appointment, we require a minimum 48 hours notification. Last minute cancellations and no shows will be charged a $25 fee that is not covered by insurance and is non refundable. To notify us of any change 48 hours prior, please call our office, leave a voicemail, text or email. If you break two appointments, we will require a 20% deposit to schedule your next appointment. If you break a third appointment you may be dismissed from the practice
  • Signature

    I certify that I have read and understand the above information to the best of my knowledge. I authorize and request my insurance company to pay directly to Town Creek Family Dentistry. I understand that my dental insurance carrier may pay less than the actual bill for services. I agree to be responsible for payment of all services rendered on my or my dependents behalf. In the event, that I default on my account(s), I agree to pay collection costs, attorney fees and/or any fees incurred in the attempts of TCFD and its affiliates, to collect this debt or any future debts.