Terms &
office policies.

Appointments and communication

Please arrive on time and provide current contact, medical and insurance information. If you cannot keep an appointment, contact the office as early as possible so the time may be offered to another patient. The office is open Monday through Friday, 8:00 am–5:00 pm, and remains open through lunch.

For an after-hours dental emergency, call the main office number and follow the recorded instructions. Electronic messages are not intended for urgent or emergency needs.

Financial responsibility and payment

Patients are responsible for all charges not paid by insurance. Patients without dental insurance are expected to pay in full at the time of treatment. For extensive care, a written payment arrangement may be established in advance; the office may require a credit card, one-half of the total balance at the time of service, and payment of the remainder within six months.

There is no finance charge for the first 60 days. After 60 days, a 1.5% finance charge may be applied monthly until the balance is paid. The office accepts cash, checks, Visa, Mastercard and Discover. Returned checks are subject to a $30 service charge.

Dental insurance

Insurance is a contract between the patient, employer and insurer. Coverage varies by plan, and participation by the practice does not mean that an insurer’s payment will cover the full charge. Patients are expected to understand their plan and remain responsible for deductibles, copayments, exclusions and any balance not covered.

As a courtesy, the office may submit claims and wait for the insurer to reimburse its portion directly. The outgoing practice site lists Anthem, Aetna PPO, Cigna PPO, Guardian PPO, Blue Shield of Northeastern New York and Empire PPO300 among participating plans. Plan participation and benefits can change and a website listing is not a guarantee of coverage or payment. Please confirm current participation with our office and benefits with your insurer before treatment.

Notice of privacy practices

The practice may use and disclose protected health information for treatment, payment and health-care operations, and as otherwise permitted or required by law. Examples include coordinating care with other providers, obtaining payment, quality improvement, appointment reminders, public-health reporting and responding to lawful requests.

Patients may request restrictions or confidential communications, inspect or obtain copies of records, request an amendment, receive an accounting of certain disclosures and receive a paper copy of the privacy notice. The practice is not required to agree to every requested restriction. Uses or disclosures not otherwise permitted generally require written authorization, which may be revoked in writing for future disclosures.

Questions or privacy complaints may be directed to the practice. A patient will not be retaliated against for filing a complaint and may also contact the U.S. Department of Health and Human Services. This clinical privacy notice is distinct from our website Privacy Policy and SMS Terms & Conditions.

Minor patients and consent

A parent, legal guardian or authorized adult must provide accurate information and consent for examination and treatment of a minor as required. The responsible party is financially responsible for services. Authorization may include routine diagnostic procedures such as examinations and X-rays, preventive care and treatment discussed with the parent or guardian.

When another adult brings a child, the parent or guardian should complete the office’s minor treatment consent form in advance and identify the authorized person and any limits on consent. Emergency treatment will be handled according to applicable law and the circumstances.

Access to and release of records

Dental records and radiographs may be released to another provider or designated recipient after the patient or authorized representative submits a signed authorization identifying the records, recipient and purpose. An authorization may be revoked in writing except to the extent the practice has already acted on it.

Requests may be subject to identity verification, reasonable preparation time and any fee permitted by law. Information received by the recipient may no longer be protected by federal privacy rules, depending on the recipient. Certain specially protected information may require additional authorization.

Original policy documents

Download the current source forms used to prepare this page. The signed patient documents and applicable law control if there is any difference between a form and this web summary.