SAN JOSE OFFICE
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GILROY OFFICE
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At South Valley Oral and Facial Surgery, we believe that your visit with us should be easy and stress-free. Whether you are simply looking for information, ready to schedule an appointment, or preparing paperwork before your next appointment, we want every step of the process to be simple.


New Patient Forms





Insurance & Financial Info


Insurance Information
If you have dental insurance we will help you determine the coverage you have available. In order to best assist you, it is important that you submit your dental and/or medical insurance information to us with your New Patient Paperwork a minimum of two business days prior to your scheduled appointment. This allows us time to contact your insurance company and obtain a breakdown of the benefits you or your employer purchased from the company.

Should you be diagnosed with treatment services, we will be able to provide you with a detailed plan which will give you an estimate of how much your insurance company may pay for each procedure, as well as the portion you will be expected to pay at the time of service.

Professional care is provided to you, our patient family, and not to an insurance company. The insurance company is responsible only to the patient as a benefit from the individual or employer plan purchase, and the patient is responsible to the doctor. We will assist you every way we can in filing your dental or medical claim, and handling insurance questions from our office on your behalf.

Financial Responsibility
In an effort to reduce the cost to you, the patient, while maintaining the highest level of professional care, we have established the financial policy as follows:

•  Payment of any account balance is due in full within 20 days of statement date
•  We gladly accept Visa, Discover, American Express, or MasterCard payments
•  Payment plans are available through CareCredit

Fees & Policies
Missed Appointment Fee
We strive to schedule an appropriate time for each patient family that visits South Valley Oral and Facial Surgery, taking into account the individual needs of each child. While we understand that emergencies happen, and it's difficult to plan for the unexpected, it's important that we respect the time of our staff, as well as those patients who may be waiting for an appointment with us.

Therefore, our missed appointment fees are as follows:
•  $25.00 per scheduled family member – Hygiene Appointment
•  $150.00 per scheduled family member – Treatment Appointment

Past Due Payment Fees
Accounts that are past due will accrue late fees in the amount of $5.00 per 30 days past due (after insurance payments have been applied). If your account is 90 days or more past due, it may be referred to a third-party for review.



Surgical Instruction Video





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SAN JOSE OFFICE
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5595 Winfield Blvd
#202
San Jose, CA 95123
Phone: 408-479-9449


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GILROY OFFICE
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7880 Wren Ave
#E152
Gilroy, CA 95020
Phone: 408-479-8788


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