Jeffrey J. Glaser DDS, MSD, PA Periodontics and Dental lmplants "Dedicated to quality care for more than 20 years" WELCOME TO OUR PRACTICE! We are happy you have selected us to care for your dental needs. Our intent is to serve you in the best possible way. We will be working with you to maintain your dental health. This involves modern dentistry and personal attention. You will be actively involved in making your dental decisions. Quality dentistry is not as expensive as neglect and we will work with you to make modern dentistry affordable. Our office hours are Tuesday through Friday from 8:00a.m. to 5:00p.m. Dr. Glaser is also available for dental emergencies after hours by calling the office at (972) 867-3900. Fees may vary based on severity, difficulty and time spent. As a courtesy to you, we will submit your dental insurance and accept assignment of benefits to minimize your up-front out of pocket expense. We do ask that you bring all dental insurance information with you and keep us updated on any changes in your coverage. The expense of billing adds to the cost of your dental care, so we ask you to pay your estimated co-payment at the time the services are rendered unless other financial arrangements have been made in advance. There will be a monthly charge of $7.50 to any remaining and neglected balances after insurance has paid in full. Our office does everything possible to remain on schedule and provide all treatment appointed for that day. Unlike a physician's office where several patients are scheduled at the same time, there is no other patient to take your place when you miss or cancel an appointment on short notice. Missed appointments affect both you and our practice. Therefore, we have a strict cancellation policy. Failure to give a 24 hour notice of cancellation will result in a cancellation fee. This fee may vary depending on the length of your reserved appointment time. lt is understood that unforeseen emergencies do arise and these situations will be evaluated on an individual basis. This policy is intended to convey our commitment to our patients and the mutual respect of their time and dental health care needs. ln case of a dental emergency, we will make every attempt to see you that day during regular office hours. lf an emergency occurs after office hours, please call our office for further recorded instructions. No prescription medication will be prescribed over the telephone to patients not of record. Patient signature Date 3804 W. 15th Street. Suite 100. Plano, fexas75O75.972/867-3900 Answered 24 Hours. FAX: 9721964-2263