Dental Clinic Patient Guidelines

Financial Obligations

1. Initial dental visits MUST be paid in full to schedule any additional appointments.

2. Church Health total patient balance must remain below $100 in order to schedule any dental appointments.

Please contact Rochelle Willis, Patient Financial Counselor, for any payment arrangements at or 901-701-2034.

3. Deposits are required in full for major services (root canals, bridges, crowns, etc.) and must be paid before receiving treatment.

Please note: ALL DEPOSITS ARE NON-REFUNDABLE.

4. For partials, dentures, crowns, root canals, and/or bridges, fees must be paid accordingly:

  • Half of the balance must be paid at first appointment. The remaining balance must be paid in full at the check-in of the final appointment with credit card or cash.
  • No checks will be accepted.
  • If payment is not received, appointments will automatically be cancelled and a new deposit fee will be required to reschedule.

Appointment Obligations

1. Patients are asked to arrive 15 minutes prior to their appointment time. Showing up late may result in rescheduling the appointment and/ or dismissal from dental program.

2. Patients who miss two dental appointments will be dismissed from the dental program.

3. Patients are required to treat all Church Health staff, residents and volunteers with kindness and respect. Failure to do so will result in immediate dismissal from the program.

4. Patients who cancel or reschedule with less than 48 hours notice may be charged a missed appointment fee.

Patient Rights to Professional Services

1. Patients will be treated with kindness and respect.

2. Patients will be given explanation for all procedures and have all reasonable questions answered.

3. Patients will enjoy full privacy of their medical records.

Church Health

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