INSURANCE
We will gladly file your insurance claims as a courtesy to you.
It is your responsibility to know your coverage and policy.
Your insurance coverage is an agreement between you
and your insurer.

We will request a pre-determination
from your insurance company to ascertain whether
they provide coverage for certain procedures and also
to finalize the amounts of coverage.

We do require payment of the estimated co-payment and
deductible at the time of service.
After your dental plan
processes your claim, you will be responsible for any
remaining balance.

If your dental plan has not paid your
account in full within 45 days, the balance must be paid
once you receive your billing statement.

Please be aware that some, and perhaps all of the services
p provided may be non covered services and may not be
considered reasonable and customary under your dental plan.

Our practice is committed to providing excellent patient
care and our charges are usual and customary for our area.



MISSED APPOINTMENTS
We certainly understand that scheduling conflicts do occur.
We require a 24-48 hour notice for cancellations.
A 25.00 cancellation fee will be applied for missed appointments.
We will make every effort to reschedule your appointment
as soon as possible.


BILLING STATEMENTS
Statements are mailed once a month.
We will also send you a statement when a payment is received
from your dental plan to inform you of your remaining balance.
Payment in full is expected on all statements unless prior
financial arrangements have been made.


RETURNED CHECKS
There will be $35.00 charge for checks that are
returned do to insufficient funds.
We do require the amount of the check
to be covered in cash.

Thank you for choosing
Dr. Joel H. Goldberg, DMD
for your dental care.

To make your first visit as convenient as possible
our patient forms are available below for you
to print and fill out prior to your appointment.

If you prefer to wait to fill out your forms
when you get here,
please allow and arrive approximately
20 minutes before your appointment time.

We look forward to meeting you and your family.

~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~

Please bring completed forms,
ID and dental insurance cards with you.

Thank you.

Call today for an appointment:
(727) 847-9631
(727) 781-3400
(352) 597-6828