1You can request an itemized bill
SAY THIS
“I’d like this in writing, including the ADA procedure codes and a copy for my records.”
PATIENT RIGHTS
You can ask. You can pause. You can say no.
Use these scripts when a visit feels rushed, unclear, or uncomfortable.
2You can request a written estimate
SAY THIS
“I’d like this in writing, including the ADA procedure codes and a copy for my records.”
3You can request a second opinion
SAY THIS
“I’d like this in writing, including the ADA procedure codes and a copy for my records.”
4You can request your dental records
SAY THIS
“I’d like this in writing, including the ADA procedure codes and a copy for my records.”
5You can request to refuse treatment
SAY THIS
“I’d like this in writing, including the ADA procedure codes and a copy for my records.”
6You can request to file a complaint
SAY THIS
“I’d like this in writing, including the ADA procedure codes and a copy for my records.”
IF YOU ARE UNDOCUMENTED
You still deserve care and respect.
Community health centers serve everyone. A Social Security number is generally not required for a cash visit.