Orthodontic treatment is an excellent investment in the overall dental, medical, and psychological well-being of children and adults. Financial considerations should not be an obstacle to obtaining this important health service. Being sensitive to the fact that different people have different needs in fulfilling their financial obligations, we are providing the following payment options:
Patient Name Date 10/19/2011
Records $
Orthodontic treatment
Retention $ -
Fee for treatment * $
Insurance Discount $
Expected Insurance ** $ -
Patient Responsibility $
* Treatment Fee includes Comprehensive Exam; Diagnostic Evaluation; All Appointments; Retainers Upon Completion; Retention Visits For One Year
** If for any reason the estimated amount is not paid by your insurance company, it becomes your responsibility
Option A: Payment-in-full
A bookkeeping credit of— 3.00% is for payment-in-full at the start of treatment
by cash or check resulting in a one-time payment of — $ 4,559.00 (no credit cards)
Option B: Office Payment Plan
An initial payment of — $ 2,825.00 is due when separators are placed or an impression for an
appliance is taken. The balance is paid in— 15 consecutive payments of— $ 125.00
Option C: Office Payment Plan - Spreading the initial payment
The initial payment is paid in 3 consecutive monthly payments of $ 941.67
the first of which is due when separators are placed or an impression for an appliance is taken.
The balance is paid in — 15 consecutive monthly payments of $ 125.00
Option D: Flexible Monthly Payment Option (Springstone Patient Financing)
- No initial payment
- Payment plans up to 72 months with low monthly payments that include a low fixed rate.
- Pre-payment can be made anytime without penalty
- Fast, confidential online application www.springstoneplan.com or (800) 630-1663
- Ask about "no interest" financing
Good credit standing required