|As a valued patient of Great Smiles Family Dental, or a legal guardian of
a patient at Great Smiles Family Dental, we ask that you read this financial
policy carefully. By signing our acknowledgment, you are in agreement of these
terms. Please note, all patients must have this acknowledgment on file before
treatment can be provided.
We are a dental healthcare provider, and as such, we perform dental services
and expect payment due upon services rendered. If you carry dental insurance,
that relationship is between you and your insurance carrier. We may submit
claims on your behalf for payment, and in most cases, payment can be made
directly to us, your provider. However, in some cases, payment may be made to
you. In these instances, we request payment to be made in full on the day
services are provided. If we bill your insurance for a claim that is not 100%
covered, we require your portion to be paid in full on the day services are
provided. There will be a $30.00 fee for any returned check. We also reserve the
right to resubmit any unpaid check for payment. In addition, we reserve the
right to charge for no-show appointments or cancellations without 24-hour prior
notice. The fee - to be determined based on the length of the appointment that
was scheduled - is not to exceed $50.00.
For your convenience, we accept cash, personal checks, Visa, MasterCard,
CareCredit zero interest payment plan. We do not offer payment plans through
Great Smiles Family Dental. To apply for the CareCredit plan, please locate
"Daniel Salvatore, DDS"
on this page, click on "Apply Now" next to his name, and follow the
directions. For more information about CareCredit, please see their website at
We ask that, should you anticipate any difficulty in paying your bill, you
communicate this with our front desk receptionist or with the doctor well in
advance of your appointment so that we may have the opportunity to discuss any
payment options available to you.
If you have children who are patients here,
please read below:
We would be appreciative if the parent, legal guardian, or other appropriate
representative (grandparent, babysitter, older sibling) stay with the minor for
the duration of the visit. We would like the opportunity to discuss the child's
care with them, and for the child's safety, we do not allow a minor under
the age of 18 to be left alone for their appointments. Please note that the
person who arrives with the minor, regardless of custody or legal status, is
also responsible for that child's financial obligation and care for that day.
We appreciate the opportunity to continue providing you and your family with
the highest quality of dental care. Thanks for your continued trust!