Highland Park and Mundelein, IL (Illinois) Orthodontists Heekyoung Jo and John H. Kelsey, DDS


Office Policies *Your First Visit* A thorough orthodontic examination will be performed and recommendations made as to the need and/or timing of treatment. If treatment is indicated and you would like to proceed, diagnostic records will be taken. Diagnostic records are made to determine the best course of treatment. Complete diagnostic records typically include a medical/dental history, clinical examination, impressions of your teeth for study models, digital photos of the patients face and teeth and x-rays. This information is used to develop a custom treatment plan for each patient. These records are also helpful in tracking the progress of treatment. *Consultation* After the doctors have evaluated your records, they will discuss your treatment with you in detail, including the cost for your particular case. *Regular Appointments* The appointment when you receive your appliances (braces, expanders, etc.) usually takes from 1 to 2 hours. You'll then see us at regular intervals 4 to 8 weeks apart for an adjustment, which takes 15 to 30 minutes. Patients are seen by appointment only. We make every effort to be on time for our patients, and ask that you extend the same courtesy to us. If you cannot keep an appointment, please notify us immediately. Cancel only if it is an emergency. It may be difficult to reschedule you since most appointments are made 4 to 8 weeks in advance.	Please help us be prepared for your first appointment by completing this Patient Information and Medical History form. Download the form below (in either Word or PDF format), print it out, complete the form and bring it with you to your first appointment. Patient Form: Word Patient Form: PDF If you're unable to read PDF files, you can download Acrobat Reader free from Adobe.
Payment & Office Policies *Cost* The cost of treatment depends on the severity of the patient's problem. You will be able to discuss fees and payment options before treatment begins. We have payment plans to suit different budgets, including a no-down-payment option. We also accept assignment from most insurance plans, and file the necessary papers to the insurance company. We work hard to make orthodontics affordable. *Fees* In an effort to keep orthodontic fees down while maintaining the highest level of professional care, we have established this financial policy: If full payment is made at the onset of treatment, we will offer a fee discount. (If you have insurance, we will offer a discount for payment of your portion of the fee that will not be covered by insurance.) To fit your individual needs, financial arrangements can be made to extend your payments over a period of months. For your convenience, we accept payment by VISA, MASTERCARD, DISCOVER and AmEx. *Insurance* If you have insurance, we will help you to determine the coverage you have available. We ask that you assign your insurance benefit to us. The balance will be arranged for you to pay (see above). Professional care is provided to you, our patient, and not to an insurance company. Thus, the insurance company is responsible to the patient and the patient is responsible to the doctor. We will help in every way we can in filing your claim and handling insurance questions from our office on your behalf.