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OFFICE POLICIES

Here are a few guidelines we need you to follow to help us make your child's visit go
smoothly while you are here.

1. The children are here to have their teeth counted, cleaned, or to make them
   healthy again. Because we want to give all our attention to them, parents are
   not permitted in the treatment area. We can't give our undivided attention to
   the children if we have to share it with the parent.



2. Because we emphasize spending quality time with each and every child, we
   schedule and see only one child at a time. Therefore, we need as much advance
   notice as possible (48 hours advance notice required) to re-schedule an
   appointment. This allows us to offer that appointment time to another person
   who may be waiting for an opening. Also if you arrive late or fail to show for a
   scheduled appointment, we reserve the right to assess a fee of $25 and/or refuse
   to reschedule.



3. If 2 or more children are scheduled together for appointment and fail to show
   without 48 hours notice, we reserve the right to schedule separate appointments
   for them in the future.



4. We schedule children age 5 and under in the morning. Patients 6 and up are
   scheduled in the afternoon. The younger children are better behaved in the
   morning before they are tired from playing. If behavior warrants, the doctor may
   choose to schedule an older child in the morning.



5. If your child is sick with the flu, chickenpox, measles, has head lice, or any other
   communicable condition, please call us as soon as possible to reschedule the
   appointment. We don't want to take the chance on spreading their "germs" to
   anyone else in the office.



6. Please be on time for your appointment. We schedule your time for the work to
   be accomplished in that appointment allotted time.



7. Please No Food of Drinks are Permitted in Our Office Area. Please help us to keep
   our office neat and clean for everyone to enjoy.



8. Our office payment policy is that payment in full is due at the time of service.
   Please be advised that our office is not able to extend credit. If you have
   insurance, we ask that you supply us with your insurance information prior to the
   appointment so that we may determine eligibility and the payment portion
   which will be your obligation. We also ask that you be prepared for any balance
   due at that appointment. Except for the amount to be paid by the insurance
   company, you will be responsible for the balance at that appointment. Any
   unpaid balance will be subject to interest and any collection fees or court costs
   incurred as the result of non-payment.

Please sign below to indicate that you agree and understand the above office policies.



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