The following is a statement of policies that we require you to read and sign prior to any treatment.


Your scheduled appointment is a reserved time-space for Dr. Kjeldsen to be with you. We ask that you please be punctual so that they have enough time to complete all of your scheduled treatments. If you are unable to keep your appointment, you must give at least a 24-hour advanced notice.  Appointments canceled less than 24 hours before the scheduled time will result in a $75 non-refundable fee.


We are happy to extend the courtesy of sending an electronic claim to your dental insurance for you.  It is your responsibility to provide our office with all of the insurance information required, prior to your appointment.  If there are any changes with your insurance plan, you are required to provide us with your new information, prior to your next appointment.  Without this information, we are unable to bill your insurance company.  Our practice is committed to providing the best treatment possible, and we charge what is Usual and Customary for experienced quality dentists in Sonoma County.  You are responsible for payment regardless of any insurance company’s arbitrary determination of dental fees.  Payment from insurance companies is considered late after 15 days from the date of service and the balance becomes your responsibility.  Your insurance policy is a contract between you and your insurance company and we are not a party to that contract.  You will be expected to contact them directly if a problem should arise.  We will provide you with the procedure number for any treatment planned so you can contact your insurance and get an estimate.  Due to Insurance industry changes, we are no longer able to obtain this information for any plans other than Delta Premier.


Payment is required at your appointment, as all of our fees are incurred when services are rendered.  In case your insurance company fails to pay the expected amount, we require a credit card to be kept in a secure HIPA compliant file until your account balance is 0.  For balance less than $100, we will charge your card and send an email to inform you. For balances over $100, we will call you prior to charging you. We are unable to carry personal loans and therefore do not offer any payment plans. If your account incurs a balance, a 5% finance charge will apply after 30 days. A balance that remains after 90 days, will incur a 40% collections fee.

Please let us know if you have any questions. We look forward to serving you.

Book Your Appointment: (707) 765-6021