What is the Pandemic Response Fee?
As Chicago is coming out of this pandemic, I am sure you have noticed many changes in the way things operate. One of these changes will be in our office. In this new world order, we will be instituting many new mandated safety measures to ensure your health. We have always taken pride in our office being modestly priced offering you a tremendous service at a reasonable fee. These new measures we have been mandated to put into practice come at a significant price. To acquire these items distributors nationally are charging up to 10X more than what we were paying prior to COVID 19 pandemic. Most practices will now be assessing a fee per patient that is not covered by your insurance and must be paid prior to your appointment.
The fee is due up front, 48 hours prior to the appointment, and can be paid via phone or txt. This fee is not refundable, in the event of a failed appointment or a rescheduled appointment. If you have any concerns of quesitons do not hesitate to call on us. We appreciate your cooperation and understanding in this matter.
I understand that I will be responsible for a total $17 fee for the Pandemic Response Fee. I understand that I am waiving my insurance guide plan guidelines and release the provider, Drs. Augustyn and Singh as well as quintessential dental from, contractual terms of my plan.