John Toumanios, DDS, LLC | Fairfield Commons | 271 US Highway 46, Suite C105 | Fairfield, NJ 07004-2457 | 973.227.1256

Susan, our Office Manager,

Practice Coordinator and

Insurance Expert, will assist you in

making payment arrangements on

your first visit. We offer a range of

payment options including: cash,

check, or credit card.

Our office is a fully approved and

accredited user of the Visa and

MasterCard Health Care Program

which will enable patients to use a

credit card to automatically cover

amounts not paid by insurance.

Patients may also choose a

comfortable amount to be

automatically billed to their Visa,

MasterCard or Discover on a monthly basis. Added fees apply.

As a service to our patients, our practice accepts most dental insurance programs. Susan

will prepare all the necessary forms for your dental benefits. However, we remind you that

your specific policy is an agreement between you and your insurance company. Please

keep in mind that you are responsible for your total obligation should your insurance

benefits result in less coverage than anticipated. Our staff will gladly submit a pre-

treatment estimate to your insurance company so that you will know what your benefits

will be.

The fees charged for services rendered to those who are insured are the usual and

customary fees charged to all our patients for similar services. Your policy may base its

allowances on a fixed fee schedule, which may or may not coincide with our usual fees.

You should be aware that different insurance companies vary greatly in the types of

coverage available and you are responsible for confirming your coverage.

FOR YOUR CONVENIENCE YOU WILL FIND PDF COPIES OF FORMS HERE THAT YOU MAY DOWNLOAD, PRINT AND COMPLETE BEFORE YOU COME FOR YOUR FIRST APPOINTMENT.

Financial Options for Payment and Insurance

Susan, our Office Manager, Practice

Coordinator and Insurance Expert,

will assist you in making payment

arrangements on your first visit. We

offer a range of payment options

including: cash, check or credit card.

Our office is a fully

approved and

accredited user of

the Visa and

MasterCard Health

Care Program which

will enable patients

to use a credit card

to automatically

cover amounts not

paid by insurance.

Patients may also

choose a

comfortable amount

to be automatically billed to their Visa, MasterCard or

Discover on a monthly basis. Added fees will apply.

As a service to our patients, our practice accepts most

dental insurance programs. Susan will prepare all the

necessary forms for your dental benefits. However, we

remind you that your specific policy is an agreement

between you and your insurance company. Please keep in

mind that you are responsible for your total obligation

should your insurance benefits result in less coverage than

anticipated. Our staff will gladly submit a pre-treatment

estimate to your insurance company so that you will know

what your benefits will be.

The fees charged for services rendered to those who are

insured are the usual and customary fees charged to all

our patients for similar services. Your policy may base its

allowances on a fixed fee schedule, which may or may not

coincide with our usual fees. You should be aware that

different insurance companies vary greatly in the types of

coverage available and you are responsible for confirming

your coverage.

FOR YOUR CONVENIENCE YOU WILL FIND PDF COPIES OF FORMS HERE THAT YOU MAY DOWNLOAD, PRINT AND COMPLETE BEFORE YOU COME FOR YOUR FIRST APPOINTMENT.

Financial

Options for

Payment and

Insurance

JOHN TOUMANIOS, DDS, LLC FAIRFIELD COMMONS, SUITE C105 271 US HIGHWAY 46 | FAIRFIELD, NJ 07004-2457 973.227.1256