Guidelines

Know what your insurance benefits are before treatment begins. If you are not sure we can submit a pre-treatment claim to your insurance for determination of available benefit amounts on your behalf.

We cannot render services on the assumption that our charges will be paid by an insurance carrier. All charges are your responsibility on the date the services are rendered. The insurance company is responsible for payment to you.

Please complete the insured or employee portion of your form and sign where indicated.

If your insurance company requires verification of continuing treatment, it is your responsibility to provide them with proof of payment. You may send them a copy or your canceled checks or cash receipts. In addition, we can provide you with a copy of your account record, which will reflect all payments made to date.

If you have any questions, please call. Many times a simple call can avert a misunderstanding. We will be happy to help you in any way we can.