| |  | If insurance is applicable, we will be happy to assist you in determining you benefits. We also accept direct payment of benefits from your insurance company and will file all necessary information and forms. If the total paid by your insurance is less than originally estimated, you are responsible for any unpaid balance owed. The treatment fee does not include diagnostic records or any services provided by any practice outside of Woodford Orthodontics. This includes, but is not limited to, regular dental cleanings and checkups, restorations, fillings, crowns or cosmetic dentistry, extractions, or other surgery, gum fiber release, or TMJ therapy. Retainer repair, replacement, or additional appliances will result in additional fees. Missed appointments that are not rescheduled 24 hours prior to the scheduled appointment are assessed a $25 fee. If a patient relocates to another area requiring treatment to be completed by another orthodontic practice, our total fee will be adjusted to reflect services provided. |