ALL-INCLUSIVE INVISALIGN
Only $3379*
Straighten BETTER, Finish FASTER, and PAY LESS
Most offices charge $5500-$7500
This option includes the $600 Invisalign New Patient Coupon*
*Available to New patients only
*Good for 2 weeks from your Invisalign Consult. Cannot be combined with any discount or coupon.
*Insurance benefits may further lower your price.
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Average Invisalign Cost:
$5500-$7500
Unbelievable All Inclusive Invisalign Treatment
Initial consult, X Rays, photos, & scan, Invisalign Clear Aligners,
Any necessary additional aligners, a single set of retainers, all
Invisalign treatment visits
We Normally Charge $3979
New Patient Invisalign Coupon 2 weeks ONLY*
** Cannot be combined with any other discount or coupon
-$600
Bringing Your Cost down to an amazingly low
Your Estimated Insurance Reimbursement sent to you over the course of treatment:
to you over the course of treatment: $______________
$3379
Upon completion of your Invisalign consultation our front desk will schedule you for a Data Collection appointment (Scan, photos, X-rays– all included). We will collect a $89 fully refundable deposit to lock in the limited time lowest discount. That deposit will be credited towards full payment due for the Data Collection appointment or fully refunded if you do not proceed with the Data Collection appointment. There is a 3% surcharge on credit cards with no surcharge on debit cards, HSA, or FSA cards.
Easy Funding Options
Do It BETTER, FASTER, for LESS COST
Patient Signature: ____________________________
Date: ___________________________
Team Member Initials: ___________________
Once payment terms are secured there are no refunds.
Option 6: CUSTOM PAYMENT:
Offered Price: $ ________________________
With Options 2 & 3 Financing
I understand and agree that I have been charged for Invisalign Data Collection (which occurs the day I pay or agree to payment terms) which has been requested and received as of the date I am signing this document. I understand and agree that all charges for Invisalign Data Collection are payments that I have made and payments that I have agreed to make are non-refundable and non-reversible for any and all reasons. I understand and agree that any attempt to reverse these charges, not fully pay these charges, dispute these charges, through financial and/or legal and/or any other means may and will incur additional costs. And I understand and agree that I will be fully responsible for any and all those additional costs included by House of Dentistry/Anuj Kapadia DMD LLC.
Patient or Responsible Party Signature: ______________________________
Date: ____________________________________
With Option 5 Estimating Insurance Coverage Agreement
I understand that if my insurance policy terminates, the maximum runs out or is already used up, or does not cover the full estimated amount, I will be responsible for resolving the remaining balance immediately.
Patient or Responsible Party Signature: ______________________________
Date: ____________________________________
Invisalign Cancellation Policy
To ensure timely and successful Invisalign treatment, we kindly ask all patients to respect the following appointment policy:
Missed Appointments/ No-Shows: If you miss your scheduled Invisalign appointment without providing prior notice, a $75 missed appointment fee will be charged to your account.
Appointment Confirmation Requirement: All Invisalign appointments must be confirmed via text message or phone call at least 24 hours in advance. Appointments that are not confirmed may be removed from the schedule and offered to another patient.
Patient Signature: ____________________________
Date: ___________________________
Team Member Initials: ___________________
Once payment terms are secured there are no refunds.