Dr. Sims Financial Arrangements

Welcome to our office! We are honored that you have chosen us as part of
your dental care provider and look forward to working with you. Our dental
practice team is committed to providing an excellent dental care experience
to you and your family, and has implemented the financial policies outlined
below to assist in that regard. These financial policies are followed by our
practice so that we can stay focused on what we do best- providing you with
personalized, comprehensive dental care services. Thank you in advance for
your cooperation

1. Payment for all treatment is due at the time of services are rendered unless
other payment arrangements have been made with our team in advance.

2. Payments for services may be made by cash, check, Visa, Master Card and Care
Credit.

3. The practice has arranged special dental care financing programs with a number
of third party Financial Institutions. These special financing programs were
arranged to reduce the financial barriers for our patients in receiving optimal
dental care treatment. Please ask your doctor or practice administrator for further
information regarding these special financing programs.

4. Fees quoted for treatment will remain in effect for 90 days and there after are
subject to change without notice. In the event clinical conditions warrant a
modification in treatment, you will be notified of modifications in treatment and
the associated fees prior to proceeding with the modified treatment.

5. If you fail to show for a scheduled appointment or cancel an appointment with
less than 24 hours advance notice and the practice is not able to appoint another
patient during the time reserved for you, the practice may charge you a fee for
such broken or late changed appointment.

6. If a check provided by you to the practice in payment for services delivered is
returned due to insufficient funds or otherwise there will be a $33.00 returned
check fee added to the amount due.

7. If services are not paid in full at the time services are delivered you will be
provided a statement for the amount due and will be expected to pay that amount
in full promptly following receipt of the statement. If the amount due is not paid in
full within 30 days of the day services are delivered you will be charged interest
on the outstanding amount retroactive to the date of service at a rate of 1.5% per
month, or 18% annually, and will be subject to a late payment fee of $29.00 ($39.00
for amounts over $1000.00) for every 30 days or portion thereof the amount due
remains unpaid. If the amount due is not paid in full within 30 days of the day
services are delivered the practice may, among other remedies/refer the
collection of the unpaid amounts to a collection agency or collection attorney and,
in such a case, you will be responsible for any and all fees and expenses of the
collection agency or collection attorney relating to the collection of unpaid
amounts.

If you have dental insurance the practice will work with you to maximize your
allowable insurance benefits and will assist you in making necessary filings
with your insurance co. It is understood that the practice will diagnose
treatment based on your dental health and not your insurance coverage. It is
further understood that, since your insurance is a contract between you and
your insurance company/employer, the practice cannot assume responsibility
for coverage or other determinations made by your insurance company and
that you will be responsible for timely payment for all treatment received from
the practice regardless of your insurance status.