Smiles That Last.
Care That Stays.

Payment is due at the time services are rendered, unless prior written financial arrangements have been approved.

The patient and/or responsible party:

• Assumes full financial responsibility for all services provided
• Agrees to pay all charges regardless of insurance coverage or reimbursement
• Understands that treatment may be delayed or declined if financial arrangements are not established

As a courtesy, our office may submit insurance claims on behalf of patients. However:

• Insurance coverage is not guaranteed
• All estimates are non-binding and subject to change
• Insurance policies are contracts between the patient and the insurance carrier
• West Market Family Dental Care is not a party to that contract

Patients are responsible for:

• Providing accurate and current insurance information
• Payment of all balances not paid by insurance

Failure to provide valid insurance information may result in full payment being required at the time of service.

We accept:

• Cash
• Check (with valid identification)
• Credit cards (Visa, Mastercard, Discover)
• Third-party financing (CareCredit, Cherry, Proceed Finance) Returned checks will incur a $40 fee.

Returned checks will incur a $40 fee.

Payment plans or financing arrangements must:

• Be approved in advance
• Be documented in writing

Failure to comply with agreed payment terms may result in:

• Immediate balance due
• Suspension or termination of treatment

• Accounts exceeding 60 days may accrue a finance charge of 5% per month (18% annually)
• Accounts over 90 days past due may be referred to collections Patients agree to pay all associated collection costs, including:
  • Collection agency fees
  • Attorney fees
  • Court costs

Treatment estimates are valid for 90 days only and may change due to:

• Clinical findings
• Changes in treatment plan
• Insurance determinations

The parent or legal guardian accompanying a minor is fully financially responsible for all services rendered.

The practice will not mediate financial or custody disputes between parents or guardians.

Appointment times are reserved specifically for each patient. Missed or late appointments impact our ability to provide care to all patients.

Patients arriving more than 10 minutes late may be rescheduled at the discretion of the office.

A minimum of 48 hours’ notice is required to cancel or reschedule an appointment. Failure to provide adequate notice will result in a $50 missed appointment fee.

A missed appointment includes:

• Failure to attend a scheduled appointment
• Cancellation with less than 48 hours’ notice Policy:
  • $50 fee per occurrence
  • Three (3) occurrences may result in dismissal from the practice

New patients who fail to attend or properly cancel their initial appointment may not be rescheduled.

Patients are responsible for maintaining accurate contact information.

Failure to receive reminders (phone, voicemail, text, or email) does not waive appointment responsibility or associated fees.

West Market Family Dental Care reserves the right to cancel or reschedule appointments due to circumstances including, but not limited to:

• Provider illness
• Staff shortages
• Equipment failure
• Facility issues
• Emergencies or unforeseen events

The office will make reasonable efforts to notify patients using available contact methods, including phone calls, voicemail, text messages, and/or email.

Patients acknowledge and agree that:

• Appointment times are not guaranteed
• The practice is not liable for:
  • Lost wages
  • Travel expenses
  • Inconvenience
  • Any related damages
• The practice will not provide compensation, reimbursement, or reciprocal cancellation fees under any circumstances

Failure to receive or respond to communications does not invalidate an office-initiated cancellation.

The office will make reasonable efforts to offer the next available appointment and accommodate urgent needs when appropriate.

West Market Family Dental Care maintains a zero-tolerance policy for:

• Abusive, aggressive, or threatening behavior
• Harassment or discrimination
• Disrespect toward staff or other patients
• Disruptive conduct that interferes with care

Violation of this policy may result in immediate dismissal from the practice.

The practice reserves the right to terminate the doctor-patient relationship at its discretion, in accordance with Pennsylvania law and professional standards. Grounds for dismissal include, but are not limited to:

• Repeated missed appointments or non-compliance
• Failure to follow recommended treatment
• Non-payment or delinquent accounts
• Violation of office policies
• Inappropriate or unsafe behavior

Dismissal may be communicated verbally and may be effective immediately. Written confirmation will follow and will be sent to the patient’s last known address.

Following dismissal:

• Emergency dental care will be available for 30 days, limited to urgent conditions only
• Patients are responsible for securing care with another provider
• Records will be released upon written authorization

Patients authorize the dentist and clinical staff to perform necessary diagnostic and treatment procedures, including radiographs, as deemed appropriate.

Patients authorize the office to:

• Submit insurance claims
• Receive payment directly from insurance carriers
• Release necessary information for billing and claims processing

Patients consent to communication via:

• Phone
• Voicemail
• Text message
• Email

for purposes including scheduling, billing, and treatment coordination.

The practice is not responsible for:

• Insurance determinations, delays, or denials
• Missed communications due to outdated contact information
• Consequences resulting from patient non-compliance

Any dispute, claim, or controversy arising out of or relating to treatment, billing, services, or these policies shall be resolved exclusively through binding arbitration.

• Arbitration shall be conducted under the rules of the American Arbitration Association
• Arbitration will take place in Pennsylvania
• A single neutral arbitrator will decide the matter
• The arbitrator’s decision shall be final and binding

Patients waive the right to a jury trial or court proceeding.

• Claims must be brought individually (no class actions)
• Claims must be filed within applicable Pennsylvania legal time limits

This Privacy Policy explains how West Market Family Dental Care (“we,” “our,” or “the practice”) collects, uses, and protects information you provide through this website (westmarketfamilydentalcare.com) and through the chat assistant available on it.

This Privacy Policy is separate from our HIPAA Notice of Privacy Practices, which governs Protected Health Information (PHI) we maintain as a covered health care provider.

Information you provide directly through the chat assistant or contact request:

• Name
• Phone number
• Email address (if voluntarily provided)
• Preferred callback time
• General reason for inquiry (e.g., “new patient,” “tooth pain,” “cleaning”)
• Any free-text message you choose to type

Information collected automatically when you visit the site:

• IP address (used briefly by our hosting provider for traffic routing and abuse prevention; not stored by us)
• Browser type and version (used by your browser; not collected by us)

We do NOT use:

• Google Analytics, Facebook Pixel, or other tracking pixels
• Marketing or behavioral advertising cookies
• Cross-site tracking

Information collected through the chat assistant or contact request is used solely to:

• Respond to your question or callback request
• Schedule, confirm, or follow up on appointments
• Provide information about our services, financing, hours, or policies
• Maintain a brief internal record of communications

We do not sell, rent, or share your information with third parties for marketing.

To operate this website and the chat assistant, we use the following service providers, each of which receives only the data necessary to perform its function:

• Vercel — hosts the website
• OpenAI — powers the natural-language chat assistant; messages you send to the chat are processed by OpenAI to generate responses
• Resend — delivers callback request emails to our office inbox

These providers process your data only on our instructions and are bound by their own privacy commitments.

Important: please do not share sensitive medical history, diagnoses, prescription information, or insurance member numbers through the chat assistant. For anything sensitive, call us directly at (570) 622‑7436.

• Chat conversations and contact requests are kept only as long as necessary to respond and follow up — typically no longer than 90 days unless you become a patient, in which case relevant records are merged into your patient chart and governed by HIPAA retention rules.
• If you do not become a patient and we have not heard from you in 12 months, we delete the inquiry record.

You may at any time:

• Ask what information we hold about you
• Ask us to correct inaccurate information
• Ask us to delete information we are not legally required to retain
• Ask us to stop contacting you

To make any of these requests, call us at (570) 622‑7436 or speak with our front desk in person.

This website is not directed at children under 13. We do not knowingly collect information from children under 13 through the chat assistant. If a parent or guardian becomes aware that a child has provided information through the site, please contact us and we will delete it.

The website is delivered over HTTPS with industry-standard encryption. The chat assistant transmits messages over encrypted connections. No method of transmission over the internet is 100% secure; we use reasonable safeguards but cannot guarantee absolute security.

We may update this Privacy Policy from time to time. Material changes will be noted at the top of this section.

Questions about this Privacy Policy:

• Phone: (570) 622‑7436
• Address: 620 W Market St, Pottsville, PA 17901

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

West Market Family Dental Care is required by law to:

• Maintain the privacy of your Protected Health Information (PHI)
• Provide you with this Notice of our legal duties and privacy practices
• Notify you following a breach of your unsecured PHI
• Follow the terms of the Notice currently in effect

“Protected Health Information” means information that identifies you and relates to your past, present, or future physical or oral health, the provision of dental care to you, or payment for that care.

For Treatment. We use your PHI to provide and coordinate dental care — for example, sharing your records with a referred specialist, lab, or oral surgeon involved in your care.

For Payment. We use and disclose PHI to obtain payment for services — for example, submitting claims to your insurance carrier or third-party financing partner you have authorized (such as Cherry, CareCredit, or Proceed Finance).

For Health Care Operations. We use PHI for the day-to-day operation of the practice — appointment reminders, quality improvement, training, accreditation, and similar internal functions.

Appointment Reminders & Scheduling. We may contact you by phone, voicemail, text message, or email to remind you of upcoming appointments, confirm scheduling, or follow up on care, consistent with the contact preferences you have provided.

Business Associates. We may share PHI with third parties (“Business Associates”) who perform services on our behalf — for example, our practice management software vendor, claims processors, IT support, or shredding services. Each Business Associate is bound by a written agreement to protect your PHI in accordance with HIPAA.

As Required by Law. We may disclose PHI when required by federal, state, or local law — for example, in response to a court order, subpoena, or to public health authorities.

Other Permitted Disclosures. We may disclose PHI without your authorization in additional limited circumstances permitted by HIPAA, including: public health activities, reports of suspected abuse or neglect, health oversight activities, judicial and administrative proceedings, law enforcement purposes, organ donation, research approved by an Institutional Review Board, to avert a serious threat to health or safety, for specialized government functions, for workers’ compensation, and to coroners, medical examiners, and funeral directors.

We will obtain your written authorization before using or disclosing your PHI for the following purposes:

• Marketing communications (other than face-to-face communications and certain treatment-related communications)
• Sale of PHI
• Most uses of psychotherapy notes (not applicable to general dental practice)
• Any other purpose not described in this Notice

You may revoke a previously given authorization in writing at any time, except where we have already acted in reliance on it.

Right to Inspect and Copy. You have the right to inspect and obtain a copy of your PHI maintained in our records. Submit a written request to our front desk; we will respond within 30 days. We may charge a reasonable, cost-based fee for copies.

Right to Request an Amendment. If you believe information in your record is inaccurate or incomplete, you may request that we amend it. We may deny the request in limited circumstances and will provide a written explanation if we do.

Right to an Accounting of Disclosures. You have the right to request an accounting of certain disclosures of your PHI made by us in the six years preceding your request, excluding disclosures for treatment, payment, health care operations, and a few other categories.

Right to Request Restrictions. You have the right to request that we restrict certain uses or disclosures of your PHI for treatment, payment, or health care operations. We are not required to agree, except in the case of a disclosure to a health plan for purposes of payment or operations if you have paid for the service in full out of pocket.

Right to Request Confidential Communications. You have the right to request that we communicate with you about your PHI in a particular way or at a particular location — for example, only by mail to a specific address. We will accommodate reasonable requests.

Right to a Paper Copy of This Notice. You may request a paper copy of this Notice at any time, even if you have agreed to receive it electronically.

Right to Be Notified of a Breach. You have the right to be notified following a breach of your unsecured PHI.

We reserve the right to change this Notice and to make the revised Notice effective for all PHI we already have about you as well as any information we receive in the future. The current Notice will be posted in our office and on this page.

If you believe your privacy rights have been violated, you may file a complaint with our office or directly with the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.

To file a complaint with our office:

• Speak with our Privacy Officer in person at the front desk, or
• Call (570) 622‑7436 and ask for the Privacy Officer, or
• Mail a written complaint to: Privacy Officer, West Market Family Dental Care, 620 W Market St, Pottsville, PA 17901

To file a complaint with HHS:

• Office for Civil Rights, U.S. Department of Health and Human Services
• 200 Independence Avenue, SW, Washington, D.C. 20201
• Phone: 1‑877‑696‑6775
• Online: hhs.gov/ocr/complaints

For questions about this Notice or to exercise any of your rights:

• Privacy Officer: West Market Family Dental Care
• Phone: (570) 622‑7436
• Address: 620 W Market St, Pottsville, PA 17901