Roger D. Sohn, D.D.S.

Cosmetic & family Dentistry
24950 Redlands Blvd. Suite B, Loma Linda, CA 92354
Tel’909-478-9777 F ax- 909—478-9779
www.cosmeticdentistrydrsohn.com
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Office Policies Regarding Financial Responsibilities and Arranqement

This is a fee for service dental office. Payment or insurance co-payments are due when services are rendered. If you have dental insurance, we will help you optimize your insurance benefits. We will ask that you pay any deductible, estimated patient portion or non—covered services at the time of treatment by one ofthe payment options as described below. As a courtesy, our office will file your claim with your insurance company. and initiate correspondence with the purpose of getting you the maximum coverage your insurance will allow. Please be aware that Insurance coverage is estimated and that your actual portion may be more, and that you are responsible for whatever portion is not covered by your Insurance. We do not want you to be surprised about the cost of dental treatment. Please insist on a pre-treatment estimate prior to work being done. Please Note: Balances remaining over 45 days will be subject to a 7.5% monthly finance charge.

Our payment ogtions include:

1. Cash, Check, Money Order or Health Savings Account.
2. Visa, MasterCard, American Express and Discover: 5% Discount for Payment in Full.
3. Care Credit Monthly Payment Plans interest free up to 24 Months OAC.

All seniors over 65 receive a 5% discount. Payment Plans are available through a third party provider, (Le. Care Credit), on approval of credit. We would be happy to assist you in making the arrangements.

On major procedures we require 100% of the estimated patient portion to be paid at the first appointment scheduled. Unless otherwise discussed with Office Manager/Treatment Coordinator.
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Appointment Cancellation Policy

Appointment times are reserved especially for you. If you must change your appointment time, we ask that you advise us immediately. There is a $50 fee for appointments that are not cancelled 24 hours prior to appointment. Major Procedures including, but not limited to, Extractions, Crowns, Implants, Root Canals, Bridges, or Dentures, have a $100 fee when not cancelled 2_4 m prior t_o appointment time.
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