As a patient at our clinic, it will be your responsibility to keep scheduled appointments. When we make your appointment we are reserving a room for your particular needs, therefore the clinic will require notification of cancellation or changed appointments of at least three full business days notice prior to any appointment (NOT 72 Hours). This courtesy makes it possible to give your reserved time to another patient who needs it.
Patient portions outstanding, after insurance coverage or otherwise have to be paid within 30 days of treatment done, if they are not collected the day of the treatment. If balance payment is not made promptly then there will be an administrative charge after 30 days of outstanding non-payment and the account will be sent to collections without notice and 28% interest will be charged. Any no show, short notice cancellations or missed appointments are subject to the same charge policy and includes any appointments made from any one of our websites. Please note that we do not accept any change of appointments or cancellations via email or online submissions through any of our websites.
All emergency and last minute appointments are given using a credit card number or deposit on file. You as a patient authorize us to charge the credit card or deposit on file if you fail to show up for the appointment except as indicated herein. Emergency patients are required to pay upfront at their first appointment for their treatment and all subsequent visits can be direct billed at the patient’s request.
I understand and agree that Dental health and accident insurance policies are an arrangement between an insurance carrier and me. Furthermore, I understand that Dr. Gurpreet Gill’s office will prepare all necessary reports and forms to assist in making collections from the insurance company and that any amount authorized to be paid directly to Dr. Gurpreet Gill will be credited to my account upon receipt. However, I clearly understand and agree that all my services rendered me are charged to me and that I am personally responsible for payment. I also understand that if I suspend or terminate my care at this office, any outstanding charges for professional services rendered to me will be immediately due and payable. I agree that I will be responsible for all attorney and legal fees if legal action becomes necessary to collect any outstanding account balances.
Please be advised that we DO NOT accept any appointment cancellations by email or by our online appointment request system and cancellations not made by phone will be subject to the above charges. We only accept cancellations over the phone during regular business hours. No cancellations will be accepted on Sunday or statutory holidays.