Appreciation Agreement

To My Appreciated Patient,

We believe in creating an ever-evolving family oriented practice that will offer the highest quality of modern dental care to all of our patients. We expect everyday as an honest team of compassionate professionals to earn the loyalty and trust of our patients, who will in turn appreciate our valuable time. We intend to be at the forefront of dental technology educating our patients as to the choices of care available and how that care can impact their overall wellbeing in a positive way.

Therefore, the following policies must be agreed upon:

  1. No-shows are not acceptable. Failure to make an appointment not only compromises your health but inconveniences other patients who may have requested an office visit during your scheduled appointment. If you cannot make an appointment (except in the case of an emergency) you are expected to call within 24 hours of your appointment to reschedule. There is a $100.00 fee for all no-show appointments and this fee is not covered by insurance. A portion of this fee will be donated to a local charity.
  2. We request that you be on time for your visits. If you are more than 10 minutes late, you may have to reschedule your appointment.
  3. If you miss an appointment you must make it up. It is critical to your health to do so to avoid setbacks in the care and maintenance of your teeth and gums.
  4. Insurance: Treatment recommendations are based on your health not on your insurance or lack thereof. If you have insurance it is your responsibility to be aware of what your benefits are. Remember insurance companies are not concerned about your health or wellbeing – we are. We will provide you with an estimate of benefits; however you are fully responsible for any treatment performed. Your benefits are a contract between you and your insurance company. We cannot be responsible for what your insurance will or will not cover.
  5. We strive to run a Zero Balance office. In order to achieve this we require 50% of the total patient out-of-pocket expense to reserve any scheduled appointments. Please speak to Janelle or Krystel if you have any questions.
  6. Emergencies: It is our goal to eliminate all of the potential dental emergencies you may have by providing care for you before it becomes a problem. In the rare instance that you do have an emergency we want you to be assured that we will take care of you. In order to do this we would like to define what a true emergency is. Swelling, bleeding, severe pain that has kept you up at night or requires medication, or a restoration in a visible area that falls out are all considered emergencies. If you have any of these symptoms we ask that you call us right away. We will provide you with the next available emergency appointment.
  7. In closing, our goal is to make your experience in our office an exceptional experience every time you visit our office. Please feel free to discuss any issues that arise. No problem is too big or too small.

I have read and agree to the terms of the Appreciation Letter.

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