Patient Policy and General Consent Form

Lake Eola Dental | 338 N Magnolia Ave Ste C, Orlando, FL 32801 | (407) 930-7007 | hello@lakeeoladental.com

This policy explains Lake Eola Dental's financial, insurance, appointment, clinical readiness, parking, conduct, and general consent requirements. Patients may be asked to acknowledge applicable policies before treatment.

Financial Policy

Payment is due at the time services are provided. Estimated patient portions, copayments, deductibles, coinsurance, non-covered services, cosmetic services, upgrades, elective treatment, and any other patient responsibility are due at the time of service.
Accepted payment methods are Visa credit or debit cards, Mastercard credit or debit cards, Discover credit cards, HSA/FSA cards, and cash.
Lake Eola Dental does not accept checks, American Express, or other payment methods unless approved in advance by the office.
Patients or account guarantors are financially responsible for charges not paid by insurance, including deductibles, copayments, coinsurance, downgraded benefits, limitations, non-covered services, denied claims, and remaining balances after insurance processing.
Treatment may be rescheduled if the estimated patient portion or an outstanding balance is not paid when due.

Insurance Information and Benefit Verification

Patients must provide current dental insurance information at least 48 hours before the scheduled appointment if they want Lake Eola Dental to attempt benefit verification before the visit.
If current insurance information is not received at least 48 hours in advance, benefits may not be verified before the appointment. The patient may be responsible for payment at the time of service, and insurance may be submitted afterward as a courtesy when applicable.
Insurance verification is a courtesy and is not a guarantee of payment. Final benefit determination is made by the insurance carrier when the claim is processed.

Appointment Policy

Appointment times are reserved specifically for each patient. Appointments must be confirmed at least 48 hours in advance or Lake Eola Dental may cancel or release the appointment time to another patient.
At least 48 hours notice is required for cancellations, rescheduling requests, or appointment changes.
Late cancellations, missed appointments, failure to confirm, or repeated appointment changes may result in limited scheduling options, same-day-only scheduling, or a requirement that future appointments be confirmed or secured in advance.
Patients who arrive late may need to have the appointment shortened or rescheduled depending on the schedule and planned treatment. Appointment reminders are a courtesy; patients remain responsible for remembering and keeping scheduled appointments.

Clinical Readiness, Medical History, and Required Records

Patients must provide complete and accurate medical history, medication lists, allergies, medical conditions, recent surgeries, pregnancy status, premedication requirements, and any updates before care is provided.
Required forms, consent forms, records, medical history updates, and requested information must be completed before the appointment when requested by the office.
Necessary X-rays and diagnostic records are part of safe diagnosis and treatment planning. Refusal to provide medical history, required consent, necessary X-rays, diagnostic records, or other required information may result in treatment being delayed, limited, or rescheduled.
If records or X-rays were taken at another office, patients should arrange for them to be sent before the appointment. The treating dentist determines whether outside records are current, diagnostic, and adequate for treatment planning.

Medical Clearance, Pregnancy Clearance, and Premedication

Medical clearance may be required before certain evaluations, cleanings, dental treatment, procedures, medications, anesthetic, or X-rays depending on the patient's medical condition, dental needs, treatment plan, medications, or health history.
Pregnant patients must notify Lake Eola Dental before the appointment and must provide current OB-GYN clearance before any dental appointment, including routine teeth cleaning appointments.
Pregnancy clearance should state any restrictions or precautions and whether dental X-rays, local anesthetic, antibiotics, pain medication, or other dental medications are permitted or restricted.
Patients who require antibiotic premedication or other premedication must notify the office before the appointment and must take the medication as directed by the prescribing provider. If required clearance or premedication is missing, treatment may be delayed or rescheduled.

General Consent for Diagnostic and General Dental Treatment

Patients may be asked to acknowledge this policy before treatment. The general consent includes permission for Lake Eola Dental to perform dental examinations, diagnostic services, charting, periodontal screening, photographs, X-rays when necessary, preventive care, and general dental treatment recommended and accepted by the patient.
The patient understands that dental treatment may involve benefits, risks, alternatives, and limitations, and that no specific result can be guaranteed.
Additional procedure-specific consent may be required for certain treatment such as oral surgery, root canal treatment, crowns, implants, sedation, periodontal therapy, or other advanced procedures.

Parking Policy

Patient parking is limited. Patients must park only in designated spaces marked with Lake Eola Dental patient parking signs and only during their scheduled appointment.
Parking in unauthorized spaces or outside the appointment time may result in ticketing or towing by the property owner or parking enforcement. Lake Eola Dental is not responsible for parking citations, towing, fees, damage, or other parking-related costs.

Respectful Communication and Patient Conduct

Lake Eola Dental maintains a safe, respectful, and professional environment. Abusive, threatening, hostile, harassing, discriminatory, profane, intimidating, or inappropriate language or behavior toward staff, providers, other patients, or visitors will not be tolerated.
If inappropriate conduct occurs, the office may pause or end the conversation, require future communication in writing, reschedule or cancel appointments, decline non-emergency treatment, dismiss the patient from the practice when appropriate, or take other steps permitted by law to protect staff and patients.