Dental Financial Responsibility

We are committed to providing you and your family the best possible care, and are pleased to discuss our professional fees with you at any time.  Your clear understanding of our financial policy is important to our professional relationship. Please ask if you have any questions about our fees, financial policy or responsibility.

PHS is not a free clinic. Patients without insurance are eligible to apply for a health care discount based on current Federal Poverty Guidelines. Health care discounts are offered on a sliding fee scale. The sliding fee scale takes into account family size and income determined on the Federal Poverty Guidelines. Nominal fees charged for essential services will be collected. Proof of household income (POI) is required to receive the sliding fee.

Payment in full is due at the time of service. In the case of a minor, the patient’s accompanying adult, parent, or guardian is responsible for payment at the time of service.


We accept most insurance plans. Patients are responsible to check with their insurance company on any restrictions.

All insurance co-pays are due at the time of service.

We will submit insurance claims on your behalf; however, we will not become involved in in disputes between you and your insurance company regarding deductibles, co-insurance, covered charges, secondary insurance, etc., other than to support factual information necessary. You are responsible for the payment of your account.

We accept cash, checks, Visa, MasterCard and debit cards.