Our goal is to help you achieve optimal dental health. We will provide treatment options, cost information, so you can make important decisions for your health. As we provide the agreed treatment plan, you are responsible for payment on all procedures rendered.
We accept: CASH, VISA, MASTERCARD, DISCOVER, AMERICAN EXPRESS ***PAYMENT FOR SERVICES IS DUE IN FULL PRIOR TO SERVICES ARE RENDERED***
DEPOSIT POLICY: Due to the extensive amount of time our staff and doctors devote to preparing and reserving uninterrupted time for reservations over 2 hours, we require a deposit of at least half of the treatment fee to make your reservation.
REFUND POLICY: Refunds can only be made when treatment plan for the paid service is changed by the dentist. Refund will be made in the original form of payment with the exception of Cash Payments. Processing times for refunds are as follows:
CASH payments – refund will be in a form of a check, processing time can take up to 21 daysCREDIT CARD payments – refunds will be returned to your credit card, processing time can take up to 10 days CARE CREDIT – refund will be returned to your care credit account, processing time can take up to 10 days
CREDIT BALANCES: Credit will only be applied to your dental account. Credit Expires after 12 months from date of Payment. Down payments are used to secure appointments, administrative, doctor, and staff time to prepare for procedures. PAYMENT toward any incomplete services will not be refunded.
RESCHEDULING/ CHANGE IN SCHEDULE POLICY: Our practice is dedicated to quality care and exceptional service. Our doctors and team spend extensive amounts of time preparing for your visit. Broken and missed appointments create scheduling problems for our team as well as other clients. If you find that you must change your appointment, we require a minimum of 48 hours notice so that we may make every effort to accommodate other clients. If proper notice is not received, a fee of $30.00 will be charged to your account and will be collected prior to rescheduling another appointment. Any recurring or excessive broken or missed appointments may result in dismissal of our practice.
UNPAID BALANCE: I accept full responsibility for any unpaid balance in my account. I understand that financing fee and late fee will be assessed in 30 day increments if payment is overdue for more than 30 days, and my account will be forwarded to collection agency in the event I fail to pay the balance by the due date. I also understand that once my account is forwarded to the collection agency, I will be responsible for additional processing fees and may blemish my credit if it remains unresolved.
INSURANCE POLICY: I accept full responsibility for the payment of such services and agree to pay for them in full before the completion of treatment. I understand that although Bravo! Dental is accepting certain insurance plans, I am ultimately responsible for the costs incurred. I authorize release of any information necessary to process dental insurance on my behalf for my reimbursement. I understand that my dental insurance is a contract between the patient and the insurance company. Bravo! Dental has no control over the insurance company’s method of payment or amount of payment.
MEDICAID/MEDICARE: I accept full responsibility for the payment of such services and agree to pay for them in full before the completion of treatment. I understand that although Bravo! Dental is accepting certain Medicaid plans, I am ultimately responsible for the costs incurred. I authorize release of any information necessary to process any dental claims on my behalf. I understand that my Medicaid/Medicare coverage is a contract between the patient and Medicaid/Medicare. Bravo! Dental has no control over Medicaid/Dental Administrator/Medicare’s method of payment or amount of payment.
To better serve you and your family, we ask that you take care of the fees for your visit at the time of service. By allowing us credit card authorization, you are giving us permission to charge any balance due.
Authorization:I authorize Bravo Dental to keep my signature on file and to charge my credit card for any agreed balance due on the day of an appointment in the practice. I understand that my information will be saved to file for future transaction on my account.