Since our office comes in contact with many different insurance companies which consist of different policies, we do ask that each parent or person responsible for their child's account to take care of the amount charged as the treatment is completed on each visit. we will be more than happy to assist you in filing your insurance.
To reduce the increased cost of billing, payment is required at the time services are rendered. We accept personal checks, cash, Visa, Mastercard, Discover, AMEX, and CareCredit. Thank you for your cooperation.
Consent For Services
Your child is a minor; therefore it is necessary that a signed permission be obtained from a parent or guardian before any necessary dental treatment can be rendered. I grant Barnes & McDonnell Pediatric Dentistry permission to provide my child's dental exam and treatment, using patient management and restorative techniques that are proper and acceptable. An appropriate explanation either oral or written will be given to parents preceding any dental treatment, services, medications operations, behavior management, techniques, local anesthesia and analgesia necessary for my child's dental needs. I understand that the treatment plan to be presented, as well as the fees outlined, could change depending on the time elapsed since the initial examination and the extent of dental decay.
I have read this release and am fully familiar with its contents.