Payment & Refund Policy
Deposit.
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).
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As such, you are required to pay Dr. Z Smiles a one-time NON-REFUNDABLE deposit of $50 (the “Deposit”) towards your treatment(s) if the treatment(s) total amount is lower than $250 to schedule your appointment concurrently with the execution of this Agreement.
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As such, you are required to pay Dr. Z Smiles a one-time NON-REFUNDABLE deposit of $100 (the “Deposit”) towards your treatment(s) if the treatment(s) total amount is higher than $500 to schedule your appointment concurrently with the execution of this Agreement.
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You understand that because appointments are not double-booked, you must provide notice of cancellation at least 48 hours prior to my scheduled appointment time. For appointments scheduled for 90 minutes or longer, you will be required to make a reservation fee of $100 prior to scheduling the appointment, which will be applied to your out-of-pocket expense for the appointment. For ALL Saturday appointments, co-payments must be paid at the time the appointment is scheduled. This reservation fee is non-refundable. If you do not show up for your appointment or you do not give adequate notice if you're unable to keep your appointment, the reservation fee will be forfeited. For appointments scheduled for less than 90 minutes in length, a cancellation fee may apply if you do not provide notice of cancellation at least 48 hours prior to your scheduled appointment time.
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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.
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You agree and acknowledge that the Deposit SHALL IN NO EVENT BE REFUNDABLE, NO MATTER THE CIRCUMSTANCES.
Payment and Terms.
You agree that, in case you are using the coverage of your dental insurance, this coverage is not a guarantee of payment (as Dental Insurances establish) and, YOU ARE RESPONSIBLE for all portions that your insurance does not pay to Dr. Z Smiles.
You understand that for any treatment less than five hundred dollars ($500) payment in full is due at the time of service. You understand that after 60 days, any unpaid balance will incur late fees. You understand that failure to pay amounts due to Dr. Z Smiles will result in your account being placed with a collection agency. In the event that your account is further referred to an attorney, you agree to pay all collection and attorney fees. ​
Cancellation.
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”). You agree and understand that should you cancel any Rescheduled Procedure, you will also be assessed a $50.00 cancellation fee for each canceled Rescheduled Procedure.
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We make every effort to schedule appointments that are most convenient for you and that fits your personal schedule. Because we do not schedule several patients at the same time, all appointments are reserved exclusively for you. In return, we ask that you make every effort not to change your reserved dental appointment.
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 pines@dr-zsmiles.com. This department has allowed us to process refunds and claims within 72 business hours.