1000 Eleven South Suite 3F, Columbia, IL 62236, US
Patient Contract - Rights and Responsibilities
New Patient Registration
We demand the complete, accurate and timely submission of your necessary paperwork to ensure that we meet the standard of care in providing health care services to you and your family.
Appointment Scheduling
When an appointment time is reserved for you, please consider that the time that has been scheduled is valuable. We reserve the right to apply broken appointment fees or collect a deposit for those who repeatedly do not appear for their appointments or cancel with shorter than the notice required in our paperwork.
Appointment deposits and reservations
We understand the challenges of traveling long distances and taking time from work and school for your appointments at our office. We also hope that you will value your longer appointment time reservations as you would a hotel room or rental car which requires a deposit to show your commitment to the financial arrangement
We respect your time
We commit ourselves fully to doing everything possible to avoid rescheduling your appointments and maintaining a timely schedule .
Absolute requirements
We will strictly enforce our requirement for our patients to submit their necessary paperwork at least 48 business hours prior to their initial appointment. Without this commitment on the part of the patient, we do not have adequate time to prepare the many aspects of care necessary to provide the level of service that we feel is necessary to care for the often complex needs of our patients.
We are a general dental office
Even though we provide highly specialized services, we are a general dental office. As a result, we are legally responsible for the entirety of the dental condition of all of our patients. Please be aware that we will absolutely be required to perform an initial dental examination prior to evaluating you for any dental appliance therapies that are unique to our office.
In other words, if you already have a family/general dentist that you are happy with and only want to utilize our services for the specialized procedures that we provide, you will be required to have your checkups, cleanings and any necessary care to treat diagnosed dental disease while you are in active appliance therapy care provided by Dr. Tenholder.
Once your active phase of care is completed, you may seek the services of another general dental office for your routine dental needs.
Please also be aware that we may not accept your contracted medical or dental insurances. Our firm belief is that insurance coverage does not determine or dictate the care that we provide to our patients.
Our commitment is to do everything possible to maximize your dental experience in our office while minimizing your out of pocket dental expenses . However, the medical-legal aspect of our role as a general dental office is clear and not negotiable.