Acknowledgement of Patient Responsibility
We are committed to providing you with the best possible care, and making your experience a positive one. The following is a statement of our Financial Policy that we require you to read and sign prior to treatment.
Payment for services is due at the time services are rendered. We accept cash, checks or all major credit cards. In some instances we may accept assignment of insurance benefits.
For your convenience, we accept Visa, MasterCard, Discover, American Express and CareCredit. We deliver the finest care at the most reasonable cost to our patients, therefore payment is due at the time service is rendered unless other arrangements have been made in advance. If you have questions regarding your account, please contact us at Nashua Office Phone Number 603-595-8889. Many times, a simple telephone call will resolve any misunderstandings.
Please remember you are fully responsible for all fees charged by this office regardless of your insurance coverage.
We will send you a monthly statement. Most insurance companies will respond within four to six weeks. Please call our office if your statement does not reflect your insurance payment within that time frame. Any remaining balance after your insurance has paid is your responsibility. Your prompt remittance is appreciated. We can make arrangements for a monthly payment plan, but that must be implemented prior to the actual procedure.
The parent or guardian accompanying a minor is responsible for all costs associated with the visit.
As a courtesy to the doctors, staff and other patients, we do expect at least 24 hours notice of a cancellation. Charges may be made for missed appointments and appointments cancelled without 24 hours advance notice.