Financial Policy for Christine M. Ford, DDS
We are committed to providing excellent periodontal health care. In order to avoid misunderstandings, we have found clarity of financial policy prior to problems to be helpful. Please read this policy carefully and sign to acknowledge that you have been provided this information.
• Please sign in and complete or update all requested forms before being seen.
• Please be prepared to pay any co-payments at the time of service.
• For private pay patients, full payment is expected at the time of service.
• Payment arrangements can be made for any procedure costing $900 or more.
• Dr. Christine Ford accepts cash, checks, Visa and MasterCard
Dental Insurance Coverage:
As a courtesy, we submit insurance claims for insured patients. To assure expedient claims processing, please provide your complete dental insurance information. A copy of your dental coverage identification card will be requested.
Your dental insurance company may not cover some of the services provided. If there is reason to believe that a service may not be covered or a service has not been authorized, we may ask that you sign a waiver, outlining the dental benefits and costs of choosing to have or not to have the service(s).
Fees:
Dr. Christine Ford is committed to providing the best treatment for patients and we charge standard fees for our area. Fees which are quoted in writing will be honored for six months.
Payment on Balances Due:
As a courtesy, we will establish a reasonable payment plan to accommodate your needs. Failure to honor financial commitments or to establish payment arrangements may result in referral to a collection agency. In addition to your outstanding balance being referred to the collection agency, you will be charged at flat fee equal to the amount the collection agency charges us to handle your collection account. All returned checks will result in a service fee. All balances due over 60 days will be subject to a finance charge of 1.5% per month.
Good doctor/patient relationships are based on understanding and open communication. Our staff will make every possible effort to clarify any misunderstanding you have concerning your balance. If you have any questions concerning your bill, please contact our office at (707) 568-7633 for rectification of billing concerns.
Miscellaneous:
Payment: There is a 5% discount for full payment by cash or check for procedures costing $900 or more 2 weeks before the scheduled procedure date. Full payment by credit card receives a 2% discount under the same conditions.
Cancellations/Missed Appointments: In an attempt to keep your cost as reasonable as possible, we make every effort to minimize overhead costs. In order to do this, we must maximize efficient appointment schedules. If you are unable to keep your appointment please notify our office as soon as possible. To avoid a cancellation fee, please give our office 3 business days notice for surgical and root planing appointment changes and 2 business days notice for all other appointments. Insurance companies do not cover this expense. You will be responsible for payment. Frequently missed appointments/cancellations interrupt the process of your treatment and may result in your referral to another practitioner.
• Please sign in and complete or update all requested forms before being seen.
• Please be prepared to pay any co-payments at the time of service.
• For private pay patients, full payment is expected at the time of service.
• Payment arrangements can be made for any procedure costing $900 or more.
• Dr. Christine Ford accepts cash, checks, Visa and MasterCard
Dental Insurance Coverage:
As a courtesy, we submit insurance claims for insured patients. To assure expedient claims processing, please provide your complete dental insurance information. A copy of your dental coverage identification card will be requested.
Your dental insurance company may not cover some of the services provided. If there is reason to believe that a service may not be covered or a service has not been authorized, we may ask that you sign a waiver, outlining the dental benefits and costs of choosing to have or not to have the service(s).
Fees:
Dr. Christine Ford is committed to providing the best treatment for patients and we charge standard fees for our area. Fees which are quoted in writing will be honored for six months.
Payment on Balances Due:
As a courtesy, we will establish a reasonable payment plan to accommodate your needs. Failure to honor financial commitments or to establish payment arrangements may result in referral to a collection agency. In addition to your outstanding balance being referred to the collection agency, you will be charged at flat fee equal to the amount the collection agency charges us to handle your collection account. All returned checks will result in a service fee. All balances due over 60 days will be subject to a finance charge of 1.5% per month.
Good doctor/patient relationships are based on understanding and open communication. Our staff will make every possible effort to clarify any misunderstanding you have concerning your balance. If you have any questions concerning your bill, please contact our office at (707) 568-7633 for rectification of billing concerns.
Miscellaneous:
Payment: There is a 5% discount for full payment by cash or check for procedures costing $900 or more 2 weeks before the scheduled procedure date. Full payment by credit card receives a 2% discount under the same conditions.
Cancellations/Missed Appointments: In an attempt to keep your cost as reasonable as possible, we make every effort to minimize overhead costs. In order to do this, we must maximize efficient appointment schedules. If you are unable to keep your appointment please notify our office as soon as possible. To avoid a cancellation fee, please give our office 3 business days notice for surgical and root planing appointment changes and 2 business days notice for all other appointments. Insurance companies do not cover this expense. You will be responsible for payment. Frequently missed appointments/cancellations interrupt the process of your treatment and may result in your referral to another practitioner.
