Dental Office Policies Form

Welcome to Tooth Harmony Dental and thank you for choosing us as your dental health care provider. Our goal is to provide you and your family with the highest quality dental care, and for you to keep your trust in us for many years to come. To ensure that we are able to maintain this high level of care, there are a few guidelines that we require our patients to follow.


Our office is open Monday to Friday 9am–6pm and alternating Saturdays 10am–3pm for any scheduling, account or general inquiries.

Cancellation Policy

While we do understand that emergencies do come up in life, committing to the appointments you schedule are an important part to both your dental care and to other patients in the practice. By giving us sufficient notice that you are unable to make an appointment, we are, in turn, able to offer this time slot to another patient who may be in pain.

We ask that you provide 2 business days notice if you need to cancel or change your appointment time. We are sympathetic to the fact that sickness and emergencies can pop up, so these matters will be considered on a case-by-case basis. If notice is not provided, a $50 fee may be applied to your account. Please keep in mind that cancellation fees are not covered by your insurance provider, so these fee’s will be your responsibility to pay. We will be unable to confirm or book any further appointments until these fee’s have been paid.

Payment Policy

We accept cash, debit, Visa, Mastercard & American Express.

Insured Patient Information

Our clinic is happy to accept payment from your insurance company for eligible dental services, as per the guidelines set out by your insurance provider. Please keep in mind that some insurance plans do not allow for assignment of benefits, which means that they will not directly pay us, and payment will only be sent to the owner of the insurance plan. In this case, we will gladly submit your claim electronically to your insurance carrier, and you will be required to pay for services up front.

Any changes to your insurance plan will not be provided to our office by your insurance company. It is your responsibility to inform us of any changes to your coverage. Charges incurred related to changes to your policy will become your responsibility. We do our best to assist you in information related to your coverage, but it is ultimately your responsibility to know your coverage as each plan is different.

If we have not received payment for your visit 90 days from your appointment date, the charges will be transferred to you. At this point we will have contacted your insurance at least 3 times to resolve any payment issues. We will be happy to provide any information that your insurance company may require to reimburse you for any payments you make past the 90-day period.

Non-Insured Patient Information

Unless previous arrangements have been made, full payment is due at the end of your appointment. Payment Plans are available but must be discussed prior to treatment. No payment plans will be approved once treatment has been completed.

Thank you for your co-operation and understanding in following these policies. If at any time, you have any questions or concerns regarding them, please do not hesitate to let us know. We are always happy to discuss any matters that will make your dental visits a pleasant experience!