Orientation Form

We are pleased that you have chosen Plano Smile Studio for your dental needs. Below is information provided to assist you in understanding our services and to help familiarize you with our office.

All fees are due from the patient at the time of service. If you have dental insurance, we will help you maximize your benefits by filing your claims for you. You will receive a reimbursement directly from your insurance company for whatever you are entitled to. Ultimately, it is the patient’s responsibility to provide our office with current, accurate insurance information. This includes provisions on your policy, which may not pay for some services provided by our office. While we are happy to assist you in following up with your insurance company, writing appeals and necessary narratives for payment, this is offered as a courtesy to you.

We realize that with larger treatment plans, payment arrangements may be necessary. Financing options are available through Capital One Health Care Finance. Our office will provide you wiht this information and discuss other ways to make the dentistry you need affordable to you.

We believe all treatment started should be completed. Incomplete treatment leads to problems, misunderstandings and usually further disease. Therefor, if a plan is agreed upon and started, it needs to be completed. We will do our best to design your treatment plan to fit your needs, while not compromising your dental health. More extensive cases may need to be phased over several appointments. Others may only require one appointment to complete. Please remember that our office does not diagnose treatment based on what your insurance company will pay. Or primary goal is to give you the best possible oral health with a treatment plan agreeable to all involved.


If you are ever unable to keep an appointment you have scheduled with us, please notify us with at least a business days notice. This allows us the opportunity to see another patient, who may wish to fill that open time. We reserve the right to charge a $50 fee for all missed appointments and short notice cancellations. If a history of short notice cancellations or “no shows” has been established, you may be required to pre pay for your dental visits before being rescheduled.

For your convenience, we accept American Express, MasterCard, Visa, checks and cash. Unpaid balances will accrue an 18% annual interest rate after 30 days from the date of service.