Terms and Conditions for Metro Dental of New Carrollton Payment Plan
By enrolling in the payment plan offered by Metro Dental of New Carrollton ("Metro Dental"), you agree to the following terms and conditions:
1. Eligibility
1.1 The payment plan is available to patients who:
Receive dental treatment at Metro Dental.
Agree to and sign the payment plan agreement.
Provide valid identification and contact information. 1.2 Approval for the payment plan is subject to credit checks or other financial evaluations, if deemed necessary by Metro Dental.
2. Payment Terms
2.1 Patients must make an initial payment of [insert percentage or dollar amount] at the time of service unless otherwise agreed upon. 2.2 The remaining balance will be divided into [insert number] equal monthly payments, due on the [insert day] of each month. 2.3 Payments can be made via:
Debit or credit card (Visa, MasterCard, etc.).
Automated bank drafts.
Cash or check (subject to approval).
3. Late Payments and Penalties
3.1 Payments not received by the due date are considered late. 3.2 A late fee of [insert amount or percentage] will be applied to overdue payments. 3.3 Metro Dental reserves the right to:
Suspend treatment for non-emergency services if payments are overdue by more than [insert number] days.
Report delinquent accounts to credit agencies after reasonable attempts to collect the debt.
4. Cancellation or Modification
4.1 Patients may cancel the payment plan at any time by paying the remaining balance in full. 4.2 Any modifications to the payment plan must be approved in writing by Metro Dental. 4.3 In the event of patient default, the full outstanding balance becomes immediately due.
5. Refunds
5.1 Refunds for prepaid services not rendered will be processed upon request. 5.2 Refunds will be reduced by any outstanding balances owed under the payment plan.
6. Collection Practices
6.1 Metro Dental may employ third-party collection agencies or legal means to recover unpaid balances. 6.2 Any fees incurred during the collection process, including legal fees, will be added to the outstanding balance.
7. Patient Responsibilities
7.1 Patients must provide accurate and up-to-date contact and payment information. 7.2 Patients are responsible for notifying Metro Dental of any changes to their financial situation that may impact their ability to meet payment obligations.
8. Privacy and Confidentiality
8.1 Metro Dental will handle patient financial information in accordance with HIPAA and applicable privacy laws. 8.2 Payment information will be used solely for processing payments under this plan and will not be shared with unauthorized third parties.
9. Termination of Agreement
9.1 Metro Dental reserves the right to terminate the payment plan if:
The patient fails to make payments as agreed.
The patient provides false or misleading information.
Metro Dental ceases to provide services to the patient for any reason.
10. Governing Law
This agreement shall be governed by and construed in accordance with the laws of the State of Maryland.
Acknowledgment and Acceptance
By clicking the Activate Plan/Make Payment button on this page, you acknowledge that you have read, understood, and agree to these terms and conditions. You also consent to the collection and use of your payment information for the purposes outlined above.