Payment Agreement

Anesthesia Fees

Fees are based on the anesthesia time required for the scheduled procedure, the level of sedation, and the patient's medical complexity. An estimate is provided prior to your appointment; the final fee is confirmed once the procedure and anesthesia time are known.

Deposit

A deposit of $150 is required to hold your appointment time and is charged by card when you complete booking. The deposit is applied toward the total anesthesia fee for the visit.

Balance Due

Any remaining balance beyond the deposit is due on the day of the procedure, before anesthesia is administered, unless other arrangements have been made in writing with the office in advance.

Insurance

Dharini Patel MD INC. does not bill dental or medical insurance directly on the patient's behalf. Upon request, an itemized receipt (superbill) will be provided so the patient may seek reimbursement from their insurer directly. Payment in full remains the responsibility of the patient or responsible party regardless of insurance outcome.

Cancellation & Rescheduling

Appointments cancelled or rescheduled with less than 48 hours' notice, or procedures that cannot proceed due to incomplete pre-anesthesia instructions (such as not fasting as directed), may forfeit the deposit. Every effort is made to accommodate genuine emergencies.

Non-Payment

Accounts not settled within 30 days of the procedure date may be referred to collections, and the responsible party agrees to cover reasonable costs of collection.