Office Policies

99 Belmont Drive, Unit 10, London ON, N6J 4K2 519-668-7574

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Office Policies

Services are to be paid for at each visit as they are performed. Be aware that Highland Woods Dentistry is not responsible for what is paid or not paid for by your benefit plan. If you have dental insurance, we will submit the claim to your insurance provider, the plan holder will be reimbursed.

Not all treatment may be covered by your dental plan, and every plan has its own unique eligibility criteria and exceptions. We do our best to help you clarify your plan. However, it is your responsibility to understand your plan details. Your treatment plan will be based on what is best for your optimal oral health, not based on what your plan covers.

The APPOINTMENT time given is reserved and preparations have been made especially for you. Respectfully, if you are unable to keep your appointment, we require 2 full business days notice. Failure to extend this courtesy may result in a fee.

Note that insurance companies do not cover fees for broken appointments.

Patient Consent

I assume full responsibility for fees associated with my dental treatment and those of my dependents.

I have read and fully understand the above conditions of treatment and I accept my responsibility as a patient at this office.

I authorize Highland Woods Dentistry to perform all dental or diagnostic procedures agreed to be necessary or advisable, including x-rays, photographs, and use of local anesthetic or other medications as indicated.

I authorize release; to my dental benefits plan administrator and the Canadian Dental Association, information contained in claims submitted electronically.

All information gathered is considered confidential and enables us to provide you with the best possible dental care. By providing us with your telephone numbers and email, you give us your consent to contact you via voice mail, email or text. I give consent to Highland Woods Dentistry to send me electronic messages. I understand that I have the right to withdraw this consent at any time.

Office Policies

99 Belmont Drive, Unit 10, London ON, N6J 4K2 519-668-7574

Office Policies

Patient Consent

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