What to Do Before Your First Visit
Being well-prepared for your appointment will ensure that the doctor and staff has all of the needed information to provide the best possible care for you. It also will help relieve any unnecessary anxiety you may be feeling. Educate yourself on your symptoms by reviewing the content on this Website. Also, take some time to review our staff page and familiarize yourself with the doctors. We look forward to your first visit.
Mission Statement
Our practice is working together to realize a shared vision of
uncompromising excellence in dentistry.
To fulfill this mission, we are committed to:
- Listening to those we are privileged to serve
- Earn the trust and respect of patients, profession and community
- Exceed your expectations
- Ensure a creative, challenging and compassionate professional environment
- Strive for continuous improvement at all levels
Patient Forms
Please print and fill out these forms so we can expedite your first
visit:
Please click and read Notice of Privacy Practice & print and sign Acknowledgement of Receipt of Notice of Privacy
If you are requesting your records be sent to Jay Freedman, DDS & Associates, PC - Please print and sent request to your prior dentist
In order to view or print these forms you will need Adobe Acrobat Reader
installed.
Click here to download it.
Dental Insurance
Is a benefit provided to about half of the USA work force. The true essence of this benefit is to provide basic care (prevention and simple restorative). Think of dental insurance as a coupon to make comprehensive and preventative care more affordable. We participate in NO insurance plans because it is Dr. Freedman’s belief that the patient and the doctor should decide on the course of treatment…. not a removed third party.
Our office has a cooperative relationship with both traditional dental insurance and Dental PPO insurance where the individual has the choice to seek care out of their network. Coleen our Financial Coordinator works relentlessly to maximize our patient’s reimbursements and has over 25 years of experience.
Financial Policy
Like most other services or products, payment is due when services are rendered. Insurance co-payments and deductibles are due at the time of services for patients with Dental PPO insurance.
WE ACCEPT CASH, CHECKS, AMERICAN EXPRESS, VISA, MASTERCARD AND DISCOVER.
Insurance Benefits
Those with dental insurance please remember that, your insurance is a contract between you, your employer and the insurance company. You are responsible for payment regardless of any arbitrary determination by your insurance company of what is usual and customary. If insurance payment is not received within 45 days then the entire amount becomes due and payable by you immediately. A pre-determination is NOT a guarantee of payment.
Minor Patients
The adult who accompanies a minor (and the minor’s parents or guardians) are responsible for full payment at the time of service.
Missed Appointments
An appointment is a confirmation that time has been reserved for your treatment. A cancellation charge of $100.00 (per half-hour of scheduled time) is assessed for each “No Show” or appointment cancelled without 24 hours’ notice.
Collection Costs
Checks returned from your bank unpaid are subject to a $ 35.00 processing charge. If your account is referred for collection (after 120 days of non-payment) you will be responsible for collection costs in the amount of 35% of the outstanding balance, all certified mail costs, court costs and reasonable attorney’s fee.
Payment Plans
Our office offers a wide variety of third party payment plans which include several options for 0% interest and for terms up to 5 years. Almost any treatment is affordable and Coleen our Financial Coordinator is available to help custom tailor a payment plan specifically for you.
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