Credit Card Authorization and Verification Form. All Charges are due on the date of service. We accept Cash, Check, Major credit cards and CareCredit. We do not accept MNSure, Ucare, or Medicare.
If you have and would like to use dental inurance, we are happy to accommodate you, but we must have a secondary payment in place to cover any unpaid charges. CareCredit, or a
major credit card would be acceptable. “Credit cards will be authorized (not charged) for the total amount due on the date of service and any remaining balance will be charged, after the insurance payment is received.