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First Visit or Emergency Visit

* Please bring any information about your health history. 


*What medications are you taking? 

*Do you currently have any medical conditions (certain uncontrolled medical conditions may require a consult with your family doctor before we can offer treatment). 

*Any additional information about your health history?


Financial Policy

* Payment is due at the time of service unless arrangements have been made prior to the start of your appointment.

* As a courtesy to our patients we will be happy to direct bill your insurance. However, we require a copy of photo identification, and a valid credit card number to be left on file. Any balance remaining unpaid by your insurance will be immediately charged to this credit card. We will not hold insurance balances for longer than 60 days from when fees were incurred. If for any reason you can not provide this information we will not be able to direct bill your insurance and payment in full will be required at time of service.

* If at any time you have questions about your account, please give us a call as many times a simple conversation can clear up any misunderstandings for either party.

For our patients that have dental insurance, please be aware:

* All fees for services are the responsibility of the patient regardless of insurance coverage. Our office will not be held responsible for non-payment from your insurance for treatment completed which was not a covered benefit, was done outside frequency limitations, exceeds your dollar maximum, deductibles, or does not match your dental insurance’s fee guide. We will always diagnose and recommend treatment based on your individual needs not on the assumption that your insurance company will reimburse any or all of the fees involved. Privacy legislation does not allow us as a third party to have access to your insurance benefit information. Therefore, we are unaware of your insurance coverage information and whether todays treatment is covered by your insurance. It is important to become familiar with all details of your insurance plan to avoid any surprises.

* Secondary insurance plans do not always cover the remaining balance left from your first insurance plans payment.

* Dental insurance should be considered as a form of subsidy towards your dental costs. It is an agreement between yourself, your employer if applicable, and your insurance company. We are not part of this contract.

* Estimates can be sent to your insurance company when requested. Minor treatment estimates must be sent out 1 week prior to appointments and major treatment estimates must be sent out at least 3 weeks prior to your appointment. It is important to know that most insurance companies will send their response directly to the policy holder and not the dental office. Please be aware that a dental estimate is only an estimate and payment from your insurance is dependent on many factors, it is not a guarantee of payment.

Cancellation / Late Policy

Stringham Dentistry requires two full business day’s notice to change or cancel any appointment. If proper notice is not given a $75.00 fee will be charged to your account.

IE: Monday Appointments need to be cancelled by 4pm the Wednesday before

Tuesday Appointments need to be cancelled by 4pm the Thursday before

We strive to be on time for all scheduled appointments. If we are running more than fifteen minutes behind we will give you a courtesy call to let you know, as sometimes emergencies or unforeseen circumstances arise. If you arrive late to your appointment we may not be able to accommodate you, as it can affect other patient’s appointments for the rest of the day. In this case we may have to reschedule your appointment for another day or time.

-Thank you for your understanding

Sincerely,
Dr. Cameron Stringham and the team at Stringham Dentistry