To promote a long-term mutually satisfying relationship, we would like to explain our office policy regarding insurance, appointments and fees. Please read carefully.

INSURANCE:  We accept most insurance plans, contact our office to verify acceptance of your plan.  DeMarta Dental does not participate in Health Management Organizations.  The patient is Fully Responsible for the charges for treatment rendered.  Any estimate given by the insurance company and/or this office is considered a guideline.  The office can make No Guarantee of the actual payment by your insurance company.  You may be expected to pay your estimated portion as services are provided.  If there is a difference after your insurance company has paid, it is your responsibility to pay the difference.

APPOINTMENTS:  When we schedule your appointment, the time is reserved exclusively for you.  We kindly request that you give us at least 48 business hours notice to cancel an appointment.  There will be a monetary charge for appointments cancelled with less than 48 hours notice.

PAYMENTS:  We accept cash, personal checks, Master Card and Visa.

SERVICE CHARGES:  A service charge of 1.5% per month (18% per annum) may be charged to accounts exceeding 60 days.  There will be a $20.00 processing fee for all returned checks.

Patient Forms

For your convenience, you may download and fill out these forms prior to your appointment.

New Patient Forms New Patient Forms
Registration Form Health History Form Dental Histroy Form
New Patient Forms HIPPA
HIPPA Privacy Practices Release of Dental records The Facts about Fillings
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