+91-9337202295 / +91-9777666000

smilexonedental@gmail.com

Financial Arrangements

Due to the highly specialized treatment that dentists provide, most treatment plans are usually complex. As a result of the amount of time that we invest in your treatment, along with material and overhead costs, we have established a payment policy which is acceptable to most patients. We request that you pay half of the estimated fee at the commencement of treatment and the balance upon completion of your crown and bridge, dentures or implants. At this time, the laboratory fee is verified and the final fee is determined. If our doctors decide to complete your treatment in one single visit then you have to pay the entire cost of treatment before the commencement of the treatment. Any additional fees incurred during the course of treatment will be billed and due upon the date of service.

Appointment policy

The complex nature of your dental treatment requires a series of appointments with explicit amounts of time periods between them to allow us to complete your treatment to the high standards that we constantly strive to achieve. Once your appointment schedule is determined it is then coordinated with the dental laboratory in order to achieve a smooth progression of your treatment. It is imperative that your appointments be maintained in order, otherwise your treatment may be delayed by several weeks. If you constantly change the dates of your appointments, this in turn affects the laboratory schedule of your treatment, and in this event we may not be able to complete your treatment by a specific date. Should you need to change a scheduled appointment, we would appreciate the courtesy of being informed at least 24 hours in advance.

Agreement

I understand the financial arrangements and agree with this payment schedule as a method of payment for my treatment. I understand that I am responsible for my dental cost regardless of any insurance coverage
Date
Print Name
Signature of Patient