Dental first financial credit card
[DOCX File]BECK DENTAL CARE
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I will be paying today by: Cash Check Credit Card Care Credit. As a condition of your treatment by this office, financial arrangements must be made in advance. The practice depends upon reimbursement from the patients for the costs incurred in their care. Financial responsibility on the part of each patient must be determined before treatment.
[DOC File]FINANCIAL POLICY - David J. Balkon, D.D.S. : Home
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In order to keep our fees down and provide quality dental care with the latest in sterilization techniques and dental procedures, we have established the following financial policy: Payment is expected in full on the day of service by cash, check, debit, or credit card. Dental Insurance:
[DOC File]Thank you for choosing our office for you dental
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This allows you to make monthly installments by credit card. A $500 deposit is due at the first appointment, an additional $1500 is due on the day the first aligner is delivered, and the remaining balance can be paid in monthly installments starting 30 days after the first aligner is delivered. Our office personnel will charge these payments to ...
[DOC File]FAMILY FIRST DENTAL OF COLUMBUS
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Separated or divorced parents of minors who are responsible for half of the cost of a child’s dental care: The parent who brings the child into the dental appointment is responsible for paying the copayment or full fee. If it is necessary, we are happy to hold a Credit/Debit card number from the …
[DOCX File]Department of Finance Statement of Financial Details form
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Please complete this form if you are applying for discretionary financial assistance on the grounds of financial hardship. Please complete . all . sections of this form. If a question does not apply to you, write N/A. If you have any questions about this form or you need help completing it, contact the Discretionary Payments Section on
[DOCX File]# 1 Dental Consultants | Dental Consulting Firm
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Financial Agreement. Our goal is to provide the highest quality of dental care possible and to have clear communication of our financial policy. ALL ACCOUNTS ARE DUE AND PAYABLE AT TIME OF SERVICE. If a procedure requires multiple appointments, payment is required in full at the first appointment. Payment options: 1. Cash. 2. Check. 3 ...
[DOC File]Dental Source Dental Health Care Plans
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Card Number:_____Expiration Date:_____ I hereby request and authorize Dental Source of Missouri & Kansas, Inc. to charge the credit card account listed above the annual membership fee to activate my membership with Dental Source of Missouri & Kansas, Inc.
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