Patient Rights & Responsibilities

At our office, we pride ourselves on forming life-long, professional relationships with our patients. We want you to be well-informed and have a clear understanding of both your rights, and responsibilities within the practice. The following is intended to promote our mission, while fostering your dignity, autonomy, and involvement in your care.

You Have the Right to..

Patient-Centered Care

Receive comprehensive, considerate, quality dental care that respects your culture, beliefs, preferences, and values

Be treated with courtesy, respect, and the highest professional, ethical, and moral conduct by our team

Schedule appointments and receive care in a timely manner

Comfort and Safety

• A safe, clean environment that is compliant with all infection-control standards
• A smoke-free environment
• Be comfortable during and after your dental procedure and/or have a family member, friend, or other individual present with you for emotional support
• Reasonable arrangements for emergency care

Privacy and Confidentiality

• Privacy of your health information and dental record
• Privacy in discussions, examinations, and treatment

Participate in Treatment

• Know the names, education, and training of your providers
• Be informed about your diagnosis, prognosis, treatment options, risks, benefits, and alternatives
• Receive a fee estimate for all recommended treatment and understand how you will be expected to pay
• Request an itemized bill, examine it, and receive an explanation of it, regardless of the source of payment for services rendered
• Seek a second opinion any time you would like one and receive all digital x-rays at no cost
• Be informed about continuing health needs
• Consent or refuse treatment and understand any associated consequences

You Have a Responsibility to..

General Considerations

• Provide honest and complete information—Please report all changes promptly
• Provide feedback about services and policies
• Let us know your needs and preferences

Maintaining Appointments

• Keep scheduled appointments— Repeated late, missed, or cancelled appointments impact our ability to provide quality care and will result in your dismissal from the practice
• Provide at least 48 hours notice for rescheduling to allow other patients the reserved time block and prevent a late fee from being billed to your account — Extenuating circumstances will always be considered
• Be timely for appointments—Failing to show up or arriving more than 15 minutes late will result in a late fee

Financial Policy

• Pay for services at the time they are rendered— A service charge of 1.5% per month is applied to all unpaid balances on accounts not paid in full within 90 days of the treatment date
• Pay any outstanding balance for yourself or dependents that is not fully covered by insurance — We will always maximize your insurance benefits first
• Pay a service charge of $25 for any returned check
• Contact our office promptly to communicate any financial hardships or concerns so we may assist you in the management of your account

Treatment Considerations

• Participate fully in the decisions related to your care
• Ask questions when you do not understand information or instructions
• Follow post-operative and prevention tips at home