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What is your financial policy?
Payments for services are due at the time services are rendered. Our financial treatment coordinator will assist you to make the cost of optimal care as easy and manageable as possible. We offer several payment options and accept major insurance carriers.

Do you accept Insurance? Which ones?
For patients with dental insurance we are happy to work with your carrier to maximize your benefit and directly bill them for reimbursement for your treatment. As a courtesy to our patients, we bill most traditional insurance plans in our office and request payment of co-pays and deductibles at the time of service. Our office accepts most PPO Insurance Plans, such as but not limited to:



Aetna PPO
Anthem Blue Cross/ Blue Shield
Assurant
Cigna PPO
Delta Dental PPO
Delta Dental Premier
Dental Health Alliance
Principal Financial Group
MetLife PPO
Guardian PPO

Do you accept credit cards?
For your convenience, we accept
     Visa, MasterCard, Discover
     CareCredit and Chase Health Advantage
     Cash and Checks




Do you have any payment plans?
We are committed in helping you get the healthy and radiant smile you’ve always wanted. We offer flexible payment plans through Care Credit.

Care Credit allows you to pay overtime with no interest, convenient low monthly payment options, with no up-front cost and no pre-payment penalties. Please call our office for more information.



What should I bring on My First Visit?
If you will utilize your insurance benefits, please remember to bring your
    
 Insurance ID card
    
 Identification card

We will need information about you to get started. We have made our Patient Forms available online for your convenience. Please download and complete the four forms below and bring them to your first visit. If you are not able to complete these forms prior to your first visit, please arrive 15 minutes before your scheduled appointment.
   
 Patient Registration Form
    Medical History
    Dental History
    Privacy Policy Acknowledgement


What can I expect on My First Visit?
We want every dental visit to be a pleasant experience, starting with your first one. Please arrive 15 minutes prior to your scheduled appointment and plan to spend between 60 - 90 minutes in our office. You will receive a comprehensive oral examination, photos, and x-rays. These will help Dr. Joanne Fernando assess your oral health and dental concerns. She will look for signs of:

Bone loss
Oral cancer
Periodontal (gum) disease
Tooth decay
TMJ problems

Dr. Joanne Fernando will customize a personal treatment plan for you based on the clinical findings of your initial examination. Your dental team will review your treatment plan options and cost.


What is your Privacy Policy?
The misuse of Personal Health Information (PHI) has been identified as a national problem causing patients inconvenience, stress and money. We want you to know that the doctor and all staff member continually undergo training so that we may understand and comply with government rules and regulations regarding the Health Insurance Portability and Accountability Act (HIPAA) with particular emphasis on the “Privacy Rule”.

The Department of Health and Human Services has established a “Privacy Rule” to help insure that your personal health information is protected from unnecessary distribution. The Privacy rule has also been created in order to provide a standard for certain health care providers to obtain their patient’s consent for uses and disclosures of health information about the patient to carry out treatment, payment or health care operations.

We strive to achieve the very highest standards of ethics, integrity, and quality in performing services for our patients. As our patient, we want you to know that we respect the privacy of your personal dental records, and will do all we can to secure and protect that privacy. We strive to always take reasonable precautions to protect your privacy. None of your private information will be released to anyone but you without your expressed written consent.

Other business that we deal with may have indirect treatment relationships with you (such as laboratories that only interact with doctors and not patients). In cases such as these, we may have to disclose some personal health information for purposes of treatment, health care operations or payment. These entities are most often not required to obtain patient consent.

You may refuse to consent to the use or disclosure of your personal health information. Should you refuse to disclose your personal health information to us, we have to right to refuse to treat you under this law. Should you disclose your information to us, but refuse to allow us to disclose it to your insurance company; you will be responsible for the full balance on your account at the time of service, instead of the customary 30 day grace period that we allow for 3rd parties to pay.


    HIPPA NOTICE OF PRIVACY PRACTICE
    HIPPA ACKNOWLEDGEMENT OF RECEIPT