Payment & Refund Policy
Scheduling a dental procedure requires the coordination of many different resources. This takes time to handle properly so that the patient will enjoy a quality experience. You acknowledge and agree that upon execution of this Invoice of Procedure Fees (the “Agreement”), Dr. Z Smiles Inc. d/b/a Dr. Z Smiles (“DR. Z SMILES”) will incur certain costs and expenses in order to schedule and prepare for your procedure(s). As such, you are required to pay to Dr. Z Smiles a one-time NON-REFUNDABLE deposit in the amount of $1,000.00 (the “Deposit”) concurrently with the execution of this Agreement. You agree and acknowledge that the Deposit SHALL IN NO EVENT BE REFUNDABLE, NO MATTER THE CIRCUMSTANCES. Specifically, failure to obtain medical clearance for any reason shall not entitle you to a refund.
You agree and acknowledge that your payment of the Deposit is valid for one (1) year. Thereafter, you will be charged an additional amount to proceed with this or any other, procedure(s) with Dr. Z Smiles. You also understand that should your procedure(s) not occur within one (1) year from the execution date of this Agreement, the prices quoted herein may be subject to change.
Payment and Terms.
You agree and understand that the above-quoted amount (the “Amount Due”) ONLY includes the following: pre-and post-operative visits; and the above-listed procedure(s).
You also agree and acknowledge that payment of the Amount Due, and any rescheduling or cancellation fees, are your responsibility. If someone other than you makes any payment(s) towards the procedure(s), then that payor must also sign this Agreement. By signing this Agreement, the payor is agreeing to be held financially liable for any and all payments made, subject to the cancellation policies, and any other applicable provisions of this Agreement.
You agree and acknowledge that with any procedure, RESULTS ARE NOT GUARANTEED. To be clear, your obligation to pay the Total Amount Due, as well as any other obligations hereunder, is operative regardless of the outcome of any procedure(s). Your payment is for the services provided hereunder, not the results. In the event that you are not satisfied with the results of your procedure(s), your treatment, or you wish to discuss any payment terms, then you should contact Dr. Z Smiles at (954) 443-3030. Moreover, you agree to mediate any payment dispute prior to seeking a chargeback from any third party.
If you schedule a revision of any procedure within one (1) year from the date of your procedure(s), you will be required to pay for: operating costs, supplies, anesthesia, dentist fees, and other ancillary costs related to that revision. If you schedule a revision for a procedure more than one (1) year from the date of your procedure(s), then you will be required to pay in full for any revisions, and subject to any change in price.
In the event that you cancel your procedure(s) (for any reason whatsoever), you agree and understand that the following applies:
(a) 15 days’ notice.
If you cancel your procedure(s), for any reason whatsoever, and such cancellation occurs fifteen (15) or more days before the scheduled procedure(s) (or at any time if no procedure has been scheduled), then you shall be entitled to the Amount Due to less the Deposit. If the Amount Due was not paid in full, then the refund shall consist of the amount then-paid to Dr. Z Smiles, less the Deposit.
(b) 7 days’ notice.
If you cancel your procedure(s), for any reason whatsoever, and such cancellation occurs less than seventh (7) days before the scheduled procedure(s), then you shall be entitled to a refund of fifty percent (50%) of the Amount Due to less the Deposit. In addition, you understand and agree that your refund may also be reduced by any costs incurred from third-party providers in connection with your procedure(s), such as, but not limited to, the costs of implants.
(c) less than 48 hours' notice.
If you cancel your procedure(s), for any reason whatsoever, and cancellation occurs less than 48 hours before the scheduled procedure(s), then you agree and acknowledge that you WILL NOT BE ENTITLED TO ANY REFUND WHATSOEVER.
You may choose to reschedule your procedure(s) (a “Rescheduled Procedure”), in which case you will be assessed an additional $50.00 rescheduling fee (the “Rescheduling Fee”) in addition to the Amount Due hereunder. You agree and understand that should you cancel any Rescheduled Procedure, you will also be assessed a $50.00 cancellation fee for each cancelled Rescheduled Procedure.
Refunds and Claims.
We are taking extreme measures in order to avoid disputes, claims, and chargebacks. We have adopted a 0 Tolerance policy in order to help the community in these uncertain times. If you would like to receive a refund for charges or change your mind about having a procedure done, please e-mail our accounting department at email@example.com. This department has allowed us to process refunds and claims within 72 business hours.