Office Policy

"*" indicates required fields

ANTHONY R. LINE, DDS. PA

21900 S. Webster, Suite A

913-592-2200

AGREEMENT

The Full Amount Is Due At Time Of Service For Our Non-insured Patients We File All Dental Insurances Except HMO'S You Will Be Billed For Any Amount The Insurance Does Not Cover We Collect 20% On All Services, Except Preventive. (Routine 6 Month Exam., Cleaning & X-Rays) KNOW YOUR INSURANCE COVERAGE, IT IS YOUR RESPONSIBILITY Patients Are Asked to Provide 24 Hour Notice When Appointments Will be Missed This Office Reserves the Right to Charge for Repeated Missed Appointments

Email Address*

Patient or Guardian Signature*

Dated*

This field is for validation purposes and should be left unchanged.

Office Policy

ANTHONY R. LINE, DDS. PA

21900 S. Webster, Suite A

OFFICE POLICY

AGREEMENT

Contact Details

Other Pages

Make Appointment

913-592-2200