In order to provide the best possible patient care, it is essential that we are given adequate notice regarding cancellations or change of appointments. Another patient who needs our care could be scheduled if we have sufficient time to notify them. We realize that unexpected things can happen, but we ask for your assistance in this regard.
The following guidelines should be followed in order to provide dental treatment to you or your family:
Payment Plans and Financial Options
In order to provide the highest quality dental care available to all of our patients and to have those services comfortably affordable, we are pleased to offer you these options for payment:
Upon request, JFDC will bill your dental insurance for services provided. Insurance benefits are only an estimate and not a guarantee for dental coverage. When requested, a pre-authorization will be submitted for a guarantee of benefits. If dental insurance is paid directly to the subscriber, the responsible party will be required to pay for the costs of the services.
The Jamestown Dental Clinic requires when a patient or legal guardian of a patient establishes an account, verification of the responsible party is required as well as being linked to the patient account. The social security number is the form of verification needed to identify the responsible party.
The responsible party is financially responsible for all charges associated with services rendered. If it becomes necessary to pursue collections for any amount owed to JFDC, the responsible party will pay for all costs and expenses, including attorney fees and interest, or collection fees for overdue payments. The responsible party is required to pay all copays and deductibles at the time of service.
Legal Consent to Make Decisions
We understand everyone has a busy schedule and on occasion a family member or friend must accompany the minor scheduled for their dental visits. For everyone’s convenience, we offer a consent form for the legal guardian to sign for individuals to make decisions regarding care for a minor under the age of 18 years old during their visit. This form is available at the front desk.