Resource Library
Finance and Insurance
Dental Financial Policy Template
A patient-facing financial policy covering estimates, insurance limitations, deposits, payment timing, balances, refunds, and responsibility.
Best used for
Where this helps inside the clinic.
New patient packet
Treatment acceptance
Payment clarity
Resource structure
What the resource should help your team capture.
Patient Responsibility
Clarify who is responsible for payment.
Responsible party
Insurance is not a guarantee
Payment due timing
Accepted payment methods
Estimates and Changes
Explain that estimates may change.
Estimate date
Treatment changes
Insurance changes
Patient approval
Deposits and Balances
Set expectations around payments.
Deposit policy
Payment plan if offered
Balance follow-up
Refund process
Acknowledgment
Document receipt and understanding.
Patient signature
Date
Staff witness
The Practice Presence for Dental Clinics
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