Terms of Service
Please review our practice policies and terms of service for endodontic treatment at Evergreen Endodontics.
Effective Date: January 1, 2024
By scheduling an appointment or receiving treatment at Evergreen Endodontics, you agree to these terms and conditions.
1. Practice Information
Practice Name: Evergreen Endodontics
Doctor: Dr. Nima Dejbod, DMD
Address: 600 NW Gilman Blvd Suite A, Issaquah, WA 98027
Phone: (425) 697-9777
Email: info@evergreenendo.com
Website: www.evergreenendo.com
2. Appointment Policies
Scheduling and Confirmation
- Appointments are scheduled on a first-come, first-served basis
- Emergency appointments are prioritized for patients experiencing severe pain
- We will confirm your appointment 24-48 hours in advance
- Please arrive 15 minutes early for your first visit to complete paperwork
Cancellation Policy
- 24-Hour Notice Required: Please provide at least 24 hours notice for appointment cancellations
- Cancellation Fee: A $75 cancellation fee may be charged for appointments cancelled with less than 24 hours notice
- No-Show Fee: A $150 no-show fee will be charged for missed appointments without notice
- Emergency Exceptions: Fees may be waived for documented medical emergencies
Late Arrival Policy
- Patients arriving more than 15 minutes late may need to reschedule
- Late arrivals may result in shortened appointment time
- Emergency patients will be accommodated when possible
3. Financial Policies
Payment Terms
- Payment Due: Payment is due at the time of service
- Accepted Forms: Cash, checks, debit cards, Visa, MasterCard, Discover, American Express
- Insurance Patients: Estimated co-payment due at time of service (typically 25-75% of procedure cost)
- Financing Available: CareCredit and Cherry financing options available
Insurance Policy
- We will file insurance claims as a courtesy to our patients
- Patients are responsible for all fees regardless of insurance coverage
- Insurance verification does not guarantee payment
- Any remaining balance after insurance payment is due within 30 days
- We do NOT bill Washington Apple Health (Medicaid), DSHS, Medicare, Molina, or Provider One
Outstanding Balances
- Accounts over 90 days past due may be sent to collections
- A 1.5% monthly service charge may be applied to overdue accounts
- Patients with outstanding balances may be required to pay in full before future treatment
4. Treatment Policies
Informed Consent
- All treatment options, risks, and alternatives will be explained
- Written consent is required before any treatment begins
- Patients have the right to refuse any recommended treatment
- Treatment costs will be discussed and approved before proceeding
Treatment Guarantee
While we strive for successful outcomes in all cases:
- No guarantee of treatment success can be made
- Endodontic treatment has a success rate of up to 90%
- Some cases may require retreatment or additional procedures
- Alternative treatments may be necessary if initial treatment fails
Post-Treatment Care
- Follow all post-treatment instructions provided
- Return to your general dentist for final restoration within 30 days
- Contact our office immediately if you experience severe pain or complications
- Attend all scheduled follow-up appointments
5. Patient Responsibilities
- Provide accurate and complete medical and dental history
- Inform us of any changes to your health status or medications
- Bring current insurance cards and identification to each appointment
- Follow all pre- and post-treatment instructions
- Maintain good oral hygiene as recommended
- Keep scheduled appointments or provide adequate notice for changes
6. Privacy and Confidentiality
- We comply with all HIPAA privacy regulations
- Patient information is kept strictly confidential
- Information may be shared with referring dentists and insurance companies as necessary
- Patients may request copies of their records at any time
Dental Record Access Fees
Record Access Fee: Per Washington State law WAC 246-08-400, which addresses fees for accessing and duplicating health care records including dental records, we charge a reasonable fee as defined in RCW 70.02.010.
- Maximum Clerical Fee: $28 for searching, handling, and duplicating records
- This fee covers administrative costs of locating, compiling, copying, and transmitting records
- Additional fees may apply if the provider personally edits confidential information from the record
- Payment is required before records are released
- This state-mandated fee structure applies to all healthcare providers in Washington
- Fee applies to all record requests including transfers to other dental providers
7. Emergency Care
- Office Hours: Monday-Friday, 7:30 AM - 5:00 PM
- After Hours: Emergency appointments available with additional $200 fee
- Severe Emergencies: Call 911 or go to the nearest emergency room
- Contact: Call (425) 697-9777 for all dental emergencies
8. Limitation of Liability
Our liability for any claim related to treatment is limited to the amount paid for the specific treatment in question. We are not responsible for indirect, consequential, or punitive damages.
9. Modifications to Terms
These terms may be updated periodically. Patients will be notified of significant changes. Continued use of our services constitutes acceptance of any modifications.
Questions About Our Terms?
If you have any questions about these terms of service, please don't hesitate to contact us.