PPE Fee Acknowledgement Form

PPE Fee Acknowledgement Form

  • Welcome back to DeAngelis Family Dentistry. Our goal is to provide a safe environment for our patients and team. Rest assured, we are taking all the necessary steps to ensure our office environment meets or exceeds the CDC and ADA guidelines. We have always advocated education for our patients in health and wellness and inline with that, wanted to inform you that all required PPE has been added to our practice protocol.

    While necessary, the new PPE requirements have increased the cost of performing dental work. For this reason, a PPE charge will be added to all appointments. The anticipated cost was not included in any third party(insurance) negotiated fees. The ADA has strongly urged those parties to include that cost in your dental benefit package in the future. The PPE charge of $20 will be added and Dr. DeAngelis will graciously pay the majority. Please be prepared to pay the $10 portion at the time of your appointment.

    DeAngelis Family Dentistry thanks you in advance for your understanding and is honored to continue providing services to you and your family.

    All our best,
    Team DeAngelis

     

    I have read and understand the information above.

  • Date Format: MM slash DD slash YYYY