Financial and insurance information
We appreciate you allowing us to provide dental care for your child. As leading providers of pediatric dental care, we wish to attract parents that take an active role in their child’s dental health and remain financially responsible. Because we value our relationship with you and believe that the best relationships are based upon understanding, we offer these clarifications on methods of payment and insurance reimbursement.
Prior to your first visit, we will request all pertinent insurance information, at your first visit we will ask for a copy of your dental insurance information to allow us to file your claim for this and all future visits. Please remember to bring all dental insurance information, as well as insurance card to every dental visit. We also ask that you contact us immediately after making any changes to your dental coverage, so we can keep our records current to help provide expeditious reimbursement of your benefits.
Methods of payment
For your convenience we accept cash, money orders, cashier’s checks, personal checks, Care Credit, Visa, MasterCard, and Discover. All returned personal checks will be assessed a $25.00 processing fee.
After attempts to collect outstanding funds and a 90-day grace period from time of service, parents/guardians not fulfilling their financial obligation will be sent to collections, as stipulated by our accountants.
Prior to completing any pediatric dentistry treatment, we will provide you with a cost estimate indicating our total fee, what we anticipate your insurance coverage to be, and your estimated out-of-pocket portion. Please remember that this is only an estimate based upon generalized information provided by your dental insurance company. An additional billing or possibly a refund may be subsequently required should information provided be inaccurate or if your insurance company pays an alternative benefit not specified to us.
We will always do our best to maximize the insurance benefits that you are eligible to receive.
We appreciate your prompt settlement of any charges that may be incurred during your child’s treatment process.
We look forward to years of close association with you, as we work together to maintain your child’s oral health! Hendersonville Pediatric Dentistry makes every effort to see patients in a timely fashion. Because we are limited by the number of patients we are able to treat during any given period of time, our schedule quickly becomes full. In an effort to provide all our patients with timely, cost-effective care, we ask that you have the courtesy to honor our 24-hour cancellation policy, this way we have time to fill this void within our schedule. This in turn will allow us to provide treatment for another patient in great need.
No charge will be made for rescheduling your appointment, provided that 24 hours notice is given so that your child’s time can be given to another patient.
Thanks for your understanding and as always, Hendersonville Pediatric Dentistry intends to attract parents that share a common interest in providing their children with the best possible dental care available and take an active role in their child’s long-term dental success.
New Patient Forms
HPD understands how valuable your time is and we never want to keep you waiting for your scheduled appointment. By completing the new patient information, provided on our web site, and arriving 15 minutes prior to your appointment time, you will be able to relax and help your child become acclimated to the new surroundings.
New Patient and Medical History: Download and Print or Fill Out Online
Notice of Privacy (HIPAA): Download and Print
Consent Form: Download and Print or Fill Out Online
Compound Release: Download and Print or Fill Out Online
Request for Access: Download and Print or Fill Out Online