Bergen Pediatric Dentistry Office Policies

Thank you for reading these policies. These are placed to safeguard our families and dental providers.

 

 

 

Safe Space:

Our office prides in creation of a safe space for ALL regardless of one’s race, religion, choices or abilities. Empathy, compassion and respect are foundational in all interactions bidirectionally.

 

 

Maximum Age for Acceptance as a New Patient:

 

We provide services to children as early as newborns to 16-years old. However, current patient who are 16 years of age and over are more than welcome to stay as long as they like. Many of our older college going patients prefer to stay at the practice and find it more appropriate come in the daytime.

 

 

Children Under 18-Years of Age MUST be Accompanied by an Adult:

 

All children under 18-years of age must be accompanied by an adult. The adult can be an older sibling or caregiver. Parent must sign Minor Consent Form and be available for emergency questions. Parent must inform us in advance for approval or disapproval of services. If the minor presents to the office by Uber or personal vehicle unaccompanied we will have to reschedule the appointment. This event is subject to our cancellation fee.

 

 

Child Accompanied by an ALTERNATE Caregiver (Child under 18):

 

If your child is accompanied by another caregiver such as a grandparent, babysitter, friend or family member, please fill out the Minor Consent Form. This form will allow your child to come with whoever you deem to do so. You may give permission for one visit or for all visits via this form. Please email the form or print and hand to caregiver for our files. Also, please note since payment is due at the time of treatment, please send in your FSA, CC, Apple Pay with the caregiver. Alternatively, you can pay in advance or be available by phone.

 

 

Payments:

 

All payments are due at the time of the visit. We are happy to provide estimates or send in a pre-treatment estimate for you. We accept the following forms of payment, AMEX, Visa, MasterCard, Care Credit, cash and Apple Pay. Credit cards subject to a 3.5% surcharge. There is no additional charge for DEBIT CARDS or FSA cards

 

Our small business relies on payment on the day of service. Thank you for your understanding.

 

 

Cancellation Fee:

 

Please know that we do not double or triple book. Your appointment time is saved for your child. Last minute cancellations greatly affect our business and ability to serve you. If your child is ill we would require a doctor note. Cancellations with 24 hours on weekdays and 48 hours on weekends are subject to a $50 charge. Frequent cancellations will influence the ability to access primetime after school appointments.

 

If the cancellation is due to a family emergency please call to let us know and if the cancellation is due to sickness please provide a doctor’s note.

 

 

Treatment Not Rendered Due to Behavior:

 

If treatment is attempted but not completed due to child’s extreme fear or resistance (no treatment is able to be done due to behavior) please know that there will be a charge of $120. This charge is there to cover the doctor’s time, the staff’s pay, and the materials used during that time. We appreciate your understanding.

 

 

IV Sedations:

 

There is a non-refundable fee of $250 for booking IV sedations. If the sedation is completed successfully the fee is applied towards the treatment. If the treatment is canceled with 48 hours the fee would not be refunded. If the child is ill we will need a doctor note. This is because the doctor blocks out the time for the service and not able to generate income due to last minute cancellation. If the child eats and breaks the fast needed for sedation the fee will not be refunded.

 

All Sedation costs will be paid on the day of the treatment before initiating the treatment.

 

Please discuss costs in advance with our OR coordinator Frannie

 

 

Behavioral and Holistic Appointments:

 

If you have a behavioral or holistic service interest, then please let the appointment coordinators know at the time of calling. They will guide you and reserve longer and specialized appointments for family and child’s needs and choices. Dr. Hernandez specializes in behavioral health and integrative services. Please read our section on personalized interventions.