Drs. Birdwell and Guffey. Comprehensive Family Dentistry. Dr. Vicki Davis Guffey, DDS 529 E Gov John Sevier Highway Phone (865)
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1 Drs. Birdwell and Guffey Comprehensive Family Dentistry Dr. Vicki Davis Guffey, DDS 529 E Gov John Sevier Highway Phone (865) Dr. Chris R. Birdwell, DDS Knoxville, TN Fax (865) birdwell-guffey@comcast.net Website: Welcome to our office! We appreciate your selection of this office to serve your dental health needs and look forward to meeting you. Our philosophy of care governs everything we do for you. It consists of the following key elements: We truly care about our patients and want you to feel comfortable in our office and with our entire team. We recognize that each patient is an individual and our goal is to help you retain your teeth in comfort, function and esthetics for a lifetime. We recognize that your time is valuable and we strive to provide treatment in the most efficient and timely manner possible. Our goal is to stay on or ahead of schedule and, thanks to our reliable patients, we usually do. We work with one patient at a time and the time you reserve is yours and yours alone. We are passionate about beautiful smiles and good oral health. We strive for excellence in providing the highest quality dentistry in a pleasant and organized setting. Enclosed you will find our new patient information forms. Please fill these out and bring them with you to your first appointment. We look forward to meeting you. Sincerely, Drs. Birdwell, Guffey, and team
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6 Drs. Birdwell and Guffey, D.D.S. PATIENT PAYMENT OPTIONS Thank you for choosing our office to help meet your dental needs. Our mission is to deliver the finest, most cost effective health care treatment in a courteous and friendly atmosphere. Following your diagnosis, the doctor will advise you of the treatment plan for your individual needs. Additionally, we will discuss with you the cost of today s treatment and any future treatment. PAYMENT IS DUE IN FULL AT THE TIME OF TREATMENT We are sensitive to the fact that some patients may not be able to pay cash for their treatment. Therefore, we do offer several alternative payment methods for your convenience. 1) Personal check or cash 2) MasterCard, Visa, Discover, and American Express 3) Care Credit- this is a separate line of credit for dental care which does not affect the balance of your other credit cards. 4) We offer a 5% discount for payment in full with cash or check for treatment over $ PATIENTS WITH INSURANCE We understand the value of insurance benefits and will assist you in obtaining maximum benefit. Please have your insurance information available. We will gladly process your insurance claim and estimate the portion not covered by your insurance. Since insurance is a contract between you and your employer, you are responsible for any balance for services rendered regardless of any insurance you may have. YOU WILL BE REQUIRED TO PAY YOUR ESTIMATED PORTION AT EACH VISIT. By doing this, we can greatly reduce the cost associated with sending monthly statements (an expense that must ultimately be added to the cost of dental care). We will be happy to discuss any questions you may have concerning our financial policy or any other aspect of your dental care. ACCOUNTS OVER 90 DAYS In the event that the account becomes delinquent, the undersigned agrees to pay all necessary collection fees, attorney fees and court costs. CANCELLATION/MISSED APPOINTMENT POLICY We ask that you provide at least 24 hours notice if you need to cancel or reschedule an appointment. $40.00 will be charged for a missed appointment or late cancellation. Exceptions can be made for emergency situations. DIVORCE CASES In cases of divorce, the individual who receives the care is responsible for payment of any patient balance at the time of service. We will not bill a divorced spouse for the patient s services. The responsibility for the payment of services for minor children belongs to the person who brings the child to the appointment. Signature of patient or responsible party Date
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