Jeremy J Zeigler DMD

Jaime E Suman DDS

11310 Huron St. Ste. 210 Northglenn, CO 80234

 

Written Financial Policy

Thank you for choosing Jeremy J Zeigler DMD. Our primary mission is to deliver the best and most comprehensive dental care available. An important part of the mission is making the cost of optimal care as easy and manageable for our patients as possible by offering several payment options.

Payment Options:

You can choose from:

            - Cash, Check, Visa, MasterCard or Discover Card

- Convenient Monthly Payment Options¹ from CareCredit Healthcare Credit Card

o    Allow you to pay over time

o    No annual fees or pre-payment penalties

Please note:

Jeremy J Zeigler DMD requires payment prior to the completion of your treatment. If you choose to discontinue care before treatment is complete, you will receive a refund less the cost of care received.

We accept payment in thirds for treatments over $300.00. For plans requiring more than 2 appointments, alternative payment arrangements may be provided.

We also offer in-house financing for treatments over $300.00. We charge 5% interest on all past due accounts.

For patients with dental insurance we are happy to work with your carrier to maximize your benefit and directly bill them for reimbursement for your treatment.²

A fee of $40.00 is charged for patients who miss or cancel without 48-hour notice.

Jeremy J Zeigler DMD charges $40.00 for returned checks.

If you have any questions, please do not hesitate to ask. We are here to help you get the dentistry you want or need.                                    

 

                                                                                                                                   

Patient, Parent or Guardian Signature                                      Date

                                                                                                                                   

Patient Name (Please Print)

¹Subject to credit approval

²However, if we do not receive payment from your insurance carrier within 60 days, you will be responsible for payment of your treatment fees and collection of your benefits directly from your insurance carrier.