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  Saturday September 04. 2010   Financial Arrangements Form





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Our office is happy to assist those individuals who are covered by dental insurance. We accept all "fee for service" insurance policies. However, because each insurance plan varies, we ask that you carefully read your policy to be sure that you are fully aware of any restrictions that apply to the benefits provided.

We will assist you in completing all forms pertaining to your claim and sending them electronically or by mail to your insurance carrier in a timely manner. We cannot, however, guarantee when, how much, or if your insurance company will pay.

Please be assured that our financial manager will always be happy to assist you in making payment arrangements that will be comfortable for you and for us.

Payment Policy

Our payment policy is as follows:

  1. Cash, check, Mastercard/Visa/Discover at time of treatment.
  2. Our financial manager will assist you in setting up a payment plan for extensive procedures.
  3. If you are covered by dental insurance, please bring your card or a form with you, with your portion completed, and your estimated portion of the payment. We bill electronically, so it is not necessary to bring forms each visit.

For NEW PATIENTS or if you are changing your payment arrangements.

Please print and fill out our payment arrangements form to bring to the office.

Payment Arrangements Form

 



 
Dr. John M. Moffat, D.D.S.
23111 Ventura Blvd., #102
Woodland Hills, CA 91364
Phone: (818) 225-0041
johnmoffatdds@sbcglobal.net

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