CANCELLATION AND INSURANCE POLICY FORM

  • Aleksandra Morel, DDS
    Family and Cosmetic Dentistry
    5501 Independence Pkwy., Suite #205
    Plano, TX 75023

    Cancellation Policy


    We require a 24 hour notice to cancel or reschedule any appointments. There will be a $50 charge for any broken appointments within a 24 hour time frame. After the second offense, we will require prepayment for all appointments. If the appointment is broken again, the pre-payment will not be refundable.

    Insurance Policy


    Insurance estimates are not a guarantee of payment. If your insurance does not pay its portion, we will bill you the balance on your account. You (patient or responsible party) are ALWAYS responsible for the entire amount. All accounts 90 days past due WILL be sent to a collection agency.

    We will send you a statement reflecting the amount due or unpaid by insurance. Please be sure we have your current address.