For your convenience we accept Visa, MasterCard and Discover. We deliver the finest care at the most reasonable cost to our patients, therefore payment is due at the time service is rendered unless other arrangements have been made in advance. If you have questions regarding your account, please contact us at Anaconda Office Phone Number 406-563-3025. Many times, a simple telephone call will clear any misunderstandings.
Please remember you are fully responsible for all fees charged by this office regardless of your insurance coverage.
We will send you a monthly statement. Most insurance companies will respond within four to six weeks. Please call our office if your statement does not reflect your insurance payment within that time frame. Any remaining balance after your insurance has paid is your responsibility. Your prompt remittance is appreciated. We can make arrangements for a monthly payment plan but this must be done prior to the actual procedure.
We strive to provide you with the best dentistry can offer. To continually provide you with the best technology and services we need to receive payment for our services. We hope this financial agreement will provide you with a clear policy that will help you maintain your financial health and good oral health. Please initial next to each statement below that you have read this policy carefully.
_____”Pay as you go” Policy
_____Payment is expected on the day of service
_____Accepted Forms of Payment (Please Circle One)
- Credit Card
- Care Credit
- Other third party finance
- In Office finance secured with a credit card
Major Dental Treatment:
_____Crowns, Root Canals and Dentures
_____50% down prior to treatment
_____50% on the day of completion prior to receiving prosthesis.
____Co-Pays will be estimated on the day of service
____Co-Pays are due on the day of Service
____I understand the above payment options and agree to the above payment option that I have selected.
Patient or Guardian_____________________________________________Date____________