Financial Agreement and Payment Options

Thank you for choosing The Kids Dentist for your child’s dental care. We are committed to providing excellent dental care with concern for your child’s personal needs. We ask that you read and sign this financial agreement statement prior to treatment to assure there is full disclosure of payment options and expectations. Our financial policy allows us to continue to provide high quality service without increasing our fees to cover excessive billing and collection costs.

We accept the following forms of payment:

Payment is expected in full for each appointment as services are rendered unless other arrangements are made.

Payment options are:

  • Cash
  • Check
  • Credit Card (MasterCard, Visa, American Express)

For the courtesy of other patients who are waiting for appointment times, please note, we require a 24 hour notice to change or cancel an appointment to avoid a charge.

Additional terms are listed in the Financial Agreement Link below.


We will do our best to get back to you in a timely manner! You can always call the office for more immediate attention or for emergencies. 262-241-0400