ASSIGNMENT OF INSURANCE:
PAYMENT OPTIONS:
Preauthorized Payment Option: This option allows you to extend payment up to 6 months with no interest attached. A 40% down payment is required prior to treatment beginning. Your remaining monthly payments are handled through pre-authorization of payment through your checking, savings or credit card account. You will simply choose a day of the month convenient for your budget and our office will deposit your payment on the day specified. This option is only available to existing patients with a credit history with our practice.
Outside Financing Options: Our office has contracted with a financing company so that we can offer you several attractive payment options. The qualification process is simple and can usually be completed within 20 to 30 minutes. You have your choice of the following options within this program:
90 days same as cash
6-12 month 0% financing
Overdue/Past Due Accounts: If your account becomes more than 90 days delinquent, Smith & Cole Dentistry reserves the right to turn your account over to an outside debt collector. Once your account has been turned over for collection, Smith & Cole will not be able to assist you with your account.
Dependents Age 18-26: We recognize that many of our patients aged 18-26 are covered by their parent/guardian’s insurance. We do require that each patient give us permission to discuss treatment and financial information with the financially responsible party. Once permission is granted, we require the parent/guardian to sign a responsible party agreement. This agreement states that the responsible party assumes liability for any treatment that we provide with the patient’s permission.