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Download Alvin Smiles Phone: 281-824-4270
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Alvin Smiles Phone: 281-824-4270 Appointment Policy Monday through Friday appointments, 25% of your copayment for proposed treatment is collected at the time you schedule your next appointment. Saturday appointments, 50% of your copayment for proposed treatment is collected at the time you schedule your appointment. A Cancellation fee of $15.00 will be issued for any failed appointments without a 24 hour notice. MEDICAID/CHIP PATIENTS: MCNA DENTAL & DENTAQUEST are notified through our automated system if you cancel or no show for your appointment. In order to keep your insurance active you must follow your insurance company’s policy. Patient/Legal Guardian Signature: ___________________ Date: __________ If you may have any questions or concerns please feel free to contact our business manager. Thank You, Management Affordable and Quality Dental Care for the Entire Family. Dr. Dhaval Thakkar, DMD | www.AlvinFamilyDentistry.com | Email: [email protected] 173 Tovrea Rd, STE #D, Alvin,Tx 77511 Alvin Smiles Phone: 281-824-4270 Politica del Cita Lunes a Viernes citas , el 25% de su copago por tratamiento propuesto se aplica en el momento de programar su próxima cita. Citas Sábado , 50 % de su copago por tratamiento propuesto se aplica en el momento de programar su cita. Se emitirá un cargo por cancelación de $ 15.00 para las citas fallidas sin un aviso de 24 horas . Pacientes de Medicaid / CHIP : MCNA DENTAL Y DentaQuest son notificados a través de nuestro sistema automatizado si se cancela o no se presenta a su cita. Con el fin de mantener su seguro activo que debe seguir la política de su compañía de seguros . Firma del Paciente / Tutor Legal: ____________________________ Fecha: __________________________ Si es posible que tenga alguna pregunta o inquietud no dude en ponerse en contacto con nuestro gerente de negocios . Gracias, Administración Affordable and Quality Dental Care for the Entire Family. Dr. Dhaval Thakkar, DMD | www.AlvinFamilyDentistry.com | Email: [email protected] 173 Tovrea Rd, STE #D, Alvin,Tx 77511
