TERMS OF TREATMENT

Your treatment fee covers the following:

  • Appliances needed to complete treatment, including the initial retainer (post braces)
  • Office visits during treatment and after as we stabilize teeth
  • Any medical records, as well as x-rays and imaging
  • Replacement of worn and damaged parts and appliances (unless we deem excessive, at which time you will be charged for repairs as well as added treatment time)

What the fee does NOT include are:

  • Any procedure received outside of our office, such as regular dental check-ups, removal of teeth, root canals, prosthetic devices, surgeries, and general dentistry, including bonding
  • Lost or damaged beyond repair appliances and retainers
  • Unexpected additional treatment time due to an accident (accidents will be reviewed on a case by case basis to determine if additional fee(s) apply)
  • Transfer of any records to another orthodontist (any x-rays and imaging become the property of Dr. Roy E. Scott DDS)
  • Any office visits after both active treatment (braces come off) and the scheduled retention period (an office visit fee will be charged)

Insurance Coverage: We will attempt to get information from your carrier about your insurance coverage and submit initial and continuing claims on your behalf. The initial filing can take up to four weeks; if we do not receive a response, it is your responsibility to contact the carrier and resolve the issue. Adjustments to payments will be made based on any fees collected from insurance. Unpaid treatment fees are your responsibility. Patients receive a balance statement from us monthly. (A $35 service fee is applied to your account for any returned checks.)

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I have reviewed the above “Financial Disclosure” and understand and accept all terms of treatment. 

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