Charles R. Payerle, DDS, MD
Oral & Maxillofacial Surgery
12001 South Freeway, Suite 207, Burleson, TX 76028
P. 817-568-6811     F. 817-568-6813

Financial Information

For your convenience, we accept Visa, MasterCard and Discover. Also we have financing available through Care Credit, a medical financing company offering 3 to 60 month financing. We deliver the finest care at the most reasonable cost to our patients, therefore payment is due at the time service is rendered unless other arrangements have been made in advance. If you have questions regarding your account, please contact us at 817-568-6811. Many times, a simple telephone call will clear any misunderstandings.

Please remember you are fully responsible for all fees charged by this office regardless of your insurance coverage. We will send you a monthly statement.

Most insurance companies will respond within four to six weeks. Please call our office if your statement does not reflect your insurance payment within that time frame. Any remaining balance after your insurance has paid is your responsibility. Your prompt remittance is appreciated.

Please download and fill-out our Financial Agreement. After you have completed the form, please make sure to bring it on your first visit to our office. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Technical Note:

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