The information that is requested on this Questionnaire, Dental History and Medical History is essential to providing you with the highest standard of dental care. The protection and privacy of your personal information is important to our office and we are committed to collecting, using and disclosing this information responsibly.
We require each patient to read and sign our office introduction prior to treatment.
Our office offers a variety of payment methods for your convenience. In addition to the traditional payments via cash, cheque, MasterCard, VISA, EFT and online bill payments, we have financing options available through Dental Card Financing. Our goal is to help you secure the treatment you need while providing options that fit your budget. If you have questions, please ask one of our front desk team members to explain your options.
Our front desk team is well trained and knowledgeable in third party payment issues. As a service to our patients, we are happy to file your dental insurance claims electronically for you. We will accept insurance benefits provided all paperwork and necessary information is complete. We do require that deductibles and co-payments be paid at the time of service. Your insurance policy is a contract between you, your employer and the insurance company, not the dental office. Any fees not covered by your insurer will be your responsibility and an estimate of your portion is the amount expected at the time of service. All balances are due upon receipt.
We would like to convey to you the importance of your scheduled appointment time. Our appointment times are specifically reserved for each patient. We require the courtesy of 2 business days advance notice by phone should you need to cancel or change your appointment. This courtesy allows us to give your appointment time to patients who may be waiting.
We require each patient to read and sign our patient communication preferences prior to treatment.
This information will enable us to maintain communication with you.
Patients with ODSP or Ontario Works benefits, please call our office for more information about your coverage.
This information will enable us to make any essential contacts.
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Tel: 613-253-2037 Fax: email@example.com