THERE IS NO FINANCE OR INTEREST CHARGES IMPOSED UNDER THIS AGREEMENT.
PAYMENTS MUST BE MADE BETWEEN 1ST - 30TH OF THE MONTH AND ARE LATE BY 1ST OF THE MONTH.
$25 CHARGE WILL APPLY TO ALL PAST DUE ACCOUNTS
$25 CHARGE FOR ALL RETURNED CHECKS
$35 CHARGE FOR A MISSED APPOINTMENT
It is the goal of Davidson Orthodontics to provide each of our patients with quality orthodontic treatment that is both affordable and convenient. That’s why we offer our patients an interest free monthly payment plan that substantially reduces the initial expense of placing the appliances (braces) and spreads this cost over the entire course of treatment. Therefore the monthly payment plan does not reflect the fee due for services rendered. The amount due for services rendered is payable if the patient stops treatment. If you would like a copy of the amortization scale, please ask.
In order to maintain this competitive fee structure and so that we may continue to offer these affordable payment terms, it is essential that monthly payments be received by our office by the 30th of each month. Prompt payment is expected and due monthly regardless of scheduled appointments. Accounts which become delinquent will result in the discontinuation of service until the account is made current. Once an account has become delinquent by 60 days the account will be turned over to an outside collection agency.
Should it be necessary to enforce the provisions of this agreement through an attorney or by legal proceedings, the undersigned promises to pay all cost of collection, including a reasonable attorney’s fee and all court costs.
I hereby certify that I have read and received a copy of foregoing disclosure statement.
Our staff makes a sincere effort to schedule convenient appointments for our patients. However, during the school term, after school appointments will be rotated to equally accommodate each patient. Advance notice of 24 hours is required to cancel an appointment.
Davidson Orthodontics hopes that all of our patients understand the importance of this policy. It is our sincere desire to treat our patients in a pleasant and congenial atmosphere. This can best be accomplished when a clear understanding exists regarding financial arrangements.
Thank you for your help in this matter.