I understand and agree that Henley Dental charges in accordance with the current year Ontario Dental Association fee guide prices for the services provided to me.I further acknowledge that any difference between the fee charged by Henley Dental and the amount covered by my CDCP insurance plan is my responsibility for payment.
Patients enrolled in the CDCP must complete their annual eligibility reassessment after filing their tax return. They will receive a letter from the federal government with renewal instructions. Renewals must be completed by the patient (or a delegate) prior to June 1st of each year.
Once you are enrolled in the Canadian Dental Care Plan (CDCP), you must renew your coverage annually at canada.ca/dental. Be sure to check your coverage before any treatment, as your co-payment may change or your coverage may expire after June 30. Renewal is your responsibility to maintain your benefits.
I hereby consent to the treatment provided by Henley Dental and agree to be responsible for any uncovered fees.
