Office Policy
I have received or downloaded and read a copy of the Privacy Practices for the Dental Office of John Toumanios, DDS.
Payment is due when treatment is rendered, unless other arrangements have been made.
Appointment times are reserved exclusively for you. If you are unable to keep your appointment, twenty-four hour notice is required or you will be charged $50 per half hour scheduled. (We have reserved 45 minutes for your routine hygiene appointment).
Your insurance policy is a contract between you and your insurance company. You hereby authorize us to release information to your insurance company on your behalf.
We will submit all claims for you; more than once, if necessary. Ultimately, however, you are the one responsible for the account. Co-pays, deductibles and non-covered fees are due when services are rendered.
The parent/guardian signing is responsible for this account, regardless of the subscriber of the insurance policy holder.
A balance outstanding over thirty (30) days is subject to 15% interest. This will be extended if financial arrangements have been made.
In the event of legal action necessary to collect an unpaid balance due for dental services, I agree to pay reasonable collection and attorney fees or other such costs as the court determines proper and consent to obtain credit report, if necessary.
If there is any change in my health or medication I will inform the dentist at the next appointment.
Financial Options
Our office will advise you on financial options after your treatment plan has been discussed with the doctor. We offer customized payment plans.
As a service to our patients, our practice participates in most PPO insurance programs. We will prepare all necessary forms for your dental claims; however, we remind you that your specific policy is an agreement between you and your insurance company. Please keep in mind that you are responsible for your total obligation should your insurance benefits result in less coverage than anticipated. Our office will pre-authorize all major work at your request, eliminating the unknown financial obligation.
The fees charged for services rendered to those who are insured are the usual and customary fees charged to all our patients for similar services. Your policy may base its allowances on a fixed fee schedule, which may or may not coincide with our usual fees. You should be aware that different insurance companies vary greatly in the types of coverage available and you are responsible for confirming your coverage.
Payment Options
We offer a range of payment options including: Check, Cash, Zelle, Venmo, Credit or Debit Cards.
Patient Forms
For your convenience please find below PDFs of forms that you may download, print and complete before you come for your first visit.