Patient Information
We’re here to provide quality care, and we need a little information from you to do that. Our team can also help you to understand your financing options, including CareCredit and Lending Club. Before your visit, check out these helpful resources, and if you have questions, give us a call.
Patient Registration
You may pre-register with our office by filling out our secure online Patient Registration Form. After you fill out the form, please make sure to press the Submit button at the bottom. We can have your completed form available for your signature at your first appointment.
Your privacy and security are our utmost concern, and we’ll never share your personal information with another party without your consent.
Failure to complete the Dental Insurance section, in detail, results in self-pay.
Care Credit
Our office accepts CareCredit payments for dental procedures.
CareCredit is a healthcare credit card that has been designed specifically for use in healthcare service financing, and it can help patients to afford dental procedures or orthodontics. CareCredit offers some advantages, so talk to our team to see if this is the right fit for you.
Lending Club
Our office also accepts Lending Club as a financing option, as well.
If you’re looking for a payment plan that works with your budget, Lending Club might be a fit. This solution helps patients to receive the care they need, without having to pay out of pocket for their services.
Our Financial Policies
Basic Policy
Payment for services rendered is due in full at the time of service. Our office accepts cash, personal checks, and credit cards. For any delinquent accounts, a collection charge of 50% will be added to the balance.
Check Acceptance Policy
We accept personal checks with a valid picture ID. If you choose to pay by check and your check is dishonored, you agree to pay a processing fee of $40, or any higher amount allowed by law, and we may electronically debit or draft your account for this fee. Also, if your check is returned for insufficient or uncollected funds, your check may be electronically re-presented for payment.
For Patients with Insurance
As a service to our patients, we will accept “assignment of benefits” and will bill your primary insurance carrier, provided proper paperwork is provided to us in advance. Every effort will be made to closely estimate your co-payments and deductibles, which are due at the time of service, but ultimate responsibility for the unpaid balance rests on you. Please understand that insurance is a contract between you and your insurance company. If an insurance carrier has not paid within 60 days of billing, any unpaid professional fees are due and payable in full from you. Any service provided that is under $300.00 must be paid at the time of service. In cases where we accept “assignment of benefits,” we will require a 30% down payment.
Cancellation Of Appointments
Our goal is to provide high quality care at a reasonable cost to our patients. In fairness to other patients, and the doctor, we require at least 24 hours notice when canceling an appointment. There is a $100.00 fee for missed appointments without 24-hour notification, which will be due and payable from you. The practice reserves the right to dismiss patients with excessive cancelled appointments.
Questions About Care? Call Archer Peak Oral Surgery
Need some help understanding your process? When you have questions about insurance, intake, or financing, reach out to our front desk. Call Archer Peak Oral Surgery in Fort Worth, TX at (817) 522-1833 today.
