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Mon-Fr: 9:00 AM – 4:00 PM

6800 MONTGOMERY BLVD NE # C Albuquerque, NM 87109

New Patient Form

Office Policies
Thank you for choosing Sandia Dental Care for your dental care needs. We believe it’s important to share our policies with our patients in advance. As always, we are pleased to answer any questions you may have or explain the treatment process in greater detail. Please read thoroughly and sign below indicating that you understand these policies and agree to comply with them. We welcome your questions and comments and are committed to providing excellent dental care services to all our patients. We appreciate the confidence you place in us.

Insurance
We may accept assignment of insurance benefits from your primary carrier after your second visit. Your coinsurance portion, including any deductible, is due at the time of service. Your co-insurance or co-payment is calculated on the information provided by your carrier at the time of estimate. Please note that your insurance policy is a contract between you and your insurance company. We accept assignment of benefits as a courtesy to our patients. Any claim not paid by your insurance carrier within 60 days will be billed to the patient.

Missed Appointments
Please help us serve you and our other patients better by keeping your scheduled appointments. Our answering machine does not accept cancellations. We prefer to speak with you in person and require 24-hour advanced notice to reschedule or cancel appointments. If you DO NOT give a 24-hour notice to reschedule or cancel your appointment there WILL BE a $60.00 fee charged to your account.

Delinquent Accounts
In the event payments are not received by agreed upon dates, a 1.75% late charge (21% APR) may be added to the delinquent account. Attorney’s fees and collection fees incurred to settle any outstanding balance are the responsibility of the patient. There will be a $25.00 fee for any returned check.

Methods of Payment
Payment for services is expected at the time of treatment unless prior arrangements have been made. For your convenience we accept: Cash, Check, Credit Card, Care Credit (MasterCard, Visa, Discover, and American Express).