Office Policy Declaration Form
Family Dental Wellness’ team of qualified dentists, hygienists and other support personnel hope to provide you and your family with quality dental care for years to come. Our goal is to educate all of our patients that your mouth “talks” to your body and your body “talks” to your mouth. In order for us to accomplish this task, it is necessary that we also have the utmost cooperation of our patients to ensure their dental health does not become compromised. Our trained team will treat you and your family in the most professional manner and will always be willing to answer any questions you may have regarding your treatment or our office policies. To accomplish this goal, a number of polices have now been implemented to help us serve you best and ensure better overall patient care. We ask that you take a few minutes to review just a couple of these changed policies.
Insurance and Payment for Services
We believe quality dental care should be straightforward and stress-free.
To help our patients understand their options clearly, we have outlined our financial and insurance policies below.
Insurance Participation
We are IN-NETWORK exclusively with CSEA.
For all other insurance providers, we operate as an OUT-OF-NETWORK practice.
However, as a courtesy to our patients, our office will prepare and submit your insurance claims on your behalf. Many out-of-network plans still offer reimbursement directly to the patient depending on the plan’s benefits.
Scheduled Appointments
Patients’ scheduled appointments are just that – scheduled appointments. We make every effort to arrange a convenient time for our patients to attend to their dental needs. In an effort to remind patients of their appointments, an appointment card is given, as well as a courtesy phone call and text are sent. Preferably, our office would like 48 hours' notice if you are unable to keep your scheduled appointment. At a minimum, we require 24 hours' notice. In the event our patients are unable to give proper notice (at least 24 hours), we reserve the right to implement an $80.00 charge to offset the overhead cost. We prefer not to charge this fee. A simple phone call by you, the patient, will relieve you of this financial burden and will allow our office to fill the opening with a patient in need of immediate dental care. Thank you in advance for your understanding.
Payment Options
To make treatment convenient and accessible, we accept:
We are committed to helping you understand your insurance benefits and financial options so you can make informed decisions about your oral health. If you have questions about coverage, estimates, or billing, our team is always here to help.
Below is a link that pulls up the PDF version of our actual financial policy that we require all patients sign prior to receiving treatment.