|Great Smiles Family Dental 500 Fox Glen Barrington, IL 60010 phone: 847.277.9800 fax: 847.852.1019|
Daniel W. Salvatore, D.D.S.
|Great Smiles Family Dental Financial Policy|
|Effective September 1, 2007|
|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, Discover, and 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.
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!