Fujioka Family Dentistry
215 NW 78th St
Vancouver, WA 98665
360-696-4439

Thank you for selecting us as your dental care provider. Our mission is to provide
EXCELLENCE in dentistry in a professional and relaxed atmosphere.

We focus on individual needs and concerns and we are committed to surpassing the expectations
of our patients, in all phases, of their dental experience.

Financial Policy

Thank you! We have received your information. See you at your appointment.

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As a courtesy, we will bill your dental insurance and help you utilize your maximum benefits; however, in order to do so we need your assistance and your understanding of our financial policy.

Payment is due at the time services are rendered, unless prior financial arrangements have been made. We accept Visa, Mastercard, Discover, check, or cash. If you have dental insurance please be prepared to pay your co-insurance at the time of treatment.

Your dental insurance is a 3 way contract between you, your employer, and your insurance company. We are only a third party relaying information your insurance provider has given to us regarding your benefits. We do our best in providing you with an estimate as to what your financial responsibility will be; however, the benefits quoted to us by your insurance company are not a guarantee of payment and the cost of treatment is ultimately your responsibility.

We bill to most insurance companies and will gladly call your insurance company before any treatment begins to get a breakdown of your dental benefits. However, it is important for our patients to know our relationship is with our patient and not the insurance company. The treatment recommendations we give you are what we feel, as a healthcare professional, is necessary for your overall oral health, not what your insurance company will or will not cover. Keep in mind, we are aware some policies pay towards the least costly treatment, such as a silver filling versus a tooth colored filling, which may make a substantial financial difference in cost. Therefore, Dr. Fujioka feels it’s important to inform patients of all the choices available.

Once you reserve a time in our schedule for treatment, we ask that you kindly give us at least 24 hours notice if you are unable to keep that appointment so that we may use that time for another patient. A $50 fee will be charged if proper notice is not given.

By signing below, you acknowledge you have read and fully understand our financial and cancellation policy.



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