Current Patient Forms

Demographic & Health History Update

Post Operative Instructions

 

New Patient Forms

Office Appointment Policy

Appointment Check List

Financial Guidelines

New Patient Information

Acknolwlegement and Notice of Privacy Practices

Kids Welcome Flyer

PAYMENT OPTIONS

Dr. Halley accepts Cash, Visa, Discover, Mastercard and American Express.    Dr. Halley is also pleased to offer Care Credit as a payment option.  Care Credit is an interest free, credit based option which allows the user to choose a payment plan that works best for them.  For more information, or to apply online, visit http://www.carecredit.com/. 

 

Dental Insurance: 
Dr. Halley's office is not a participating provider with any dental insurance company; however, we will file your insurance as a courtesy.  We do not file secondary insurance but will give you the proper forms and instructions to file it yourself after the primary insurance has paid.  Please know you are responsible at the time of the visit for what we estimate your insurance company will not pay. If our estimate was not enough, we will send you an invoice for the balance; if our estimate was too much we will happily refund you the amount owed.  Please call for additional information on certain insurances and our specific policies and call your insurance company to inquire about how they treat out-of-network providers.
*Please note: if you are sending your child with another caregiver other than yourself (the legal guardian), payment is still due at time of service.

As of January 1st 2011 Halley White Pediatric Dentistry will NO LONGER ACCEPT CHECKS of any kind for payment.  We apologize for any inconvenience and would be happy to explain our policy to you if you like.  910-686-1869