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Payment Agreement Templates for Dental Practices

February 04, 2025
Written by: Jordon Comstock

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Payment Agreement Templates for Dental Practices: Get Paid on Time & Stop Chasing Patients for Money

(Or: How to Stop Playing the “Will They Pay Me?” Game and Start Running a Profitable Practice!)


Let’s Be Honest: Dental Payment Problems Are a Nightmare

If you’re a dentist, office manager, or billing specialist, you already know one cold, hard truth:

Patients love their new smile… but not their bill.

Every day, dental offices deal with:

Patients who “forget” to pay.
Insurance companies denying claims.
Big treatment plans getting rejected because of sticker shock.

Here’s the kicker—if you don’t have a solid payment agreement in place, you’re going to lose money. A LOT of it.

The solution? A rock-solid payment agreement template that protects your practice and gets you PAID.

What You’ll Learn in This Guide:

How to create airtight dental payment agreements.
How membership programs eliminate billing headaches.
How one practice used BoomCloud to scale to $20K+ in Monthly Recurring Revenue (MRR).
Why membership patients spend 2X-4X more than insurance patients.
Free resources for consent forms & payment templates.

Let’s fix your billing game once and for all.


Step 1: Why Every Dental Practice Needs a Payment Agreement

Fact: If you don’t have a clear payment agreement in writing, you WILL run into:

Patients ghosting you after getting major work done.
Arguments over “I didn’t know it would cost that much!”
Legal nightmares when patients dispute charges.

What a Payment Agreement Does:

✔️ Sets clear expectations for costs & payment schedules.
✔️ Protects you from chargebacks & disputes.
✔️ Helps patients commit to their treatment plan.

Pro Tip: Use digital consent forms so patients sign BEFORE treatment even starts.

Grab free consent form tools here: BoomCloud Consent Form Tools


Step 2: What to Include in a Payment Agreement Template

A good payment agreement should cover everything upfront, so there’s NO confusion.

1. Clear Treatment Cost Breakdown

Spell out EXACTLY what’s being charged.
List each procedure & its price.
Make sure patients understand what’s included—and what’s NOT.

Pro Tip: Have a front desk team member walk through the costs with the patient in person.


2. Payment Options & Due Dates

Patients need to know:

✔️ When payment is due.
✔️ What payment methods are accepted.
✔️ What happens if they miss a payment.

Best Options for Payment Plans:
Pay-in-Full Discount – Save 10% if they pay everything upfront.
Monthly Payment Plan – Split payments over 6-12 months.
In-House Membership Plan – Patients pay a flat monthly fee for routine care & discounts on additional treatment.

Want to automate payments? Use BoomCloudApps.com to manage in-house memberships & billing.


3. What Happens If They Don’t Pay? (Late Fees & Collection Policies)

Nobody wants to be the bad guy, but you NEED a policy for:

Late payments.
Missed payments.
Collections (if necessary).

Example Clause:

“A late fee of $25 will be charged for any payment more than 5 days past due. Accounts past due for 60+ days may be sent to collections.”

Pro Tip: 80% of billing issues happen because patients “forget.” Set up automated reminders via text & email.


Step 3: The Secret Weapon – Membership Plans Eliminate Billing Issues

What if you could eliminate billing headaches altogether? That’s what a dental membership plan does.

Patients pay YOU directly—no insurance headaches.
Predictable, recurring revenue (MRR & ARR).
Increased patient loyalty (membership patients visit 2X-4X more).

How a Membership Plan Works

Patients pay a flat monthly or annual fee.
Preventive care is covered (cleanings, exams, X-rays).
They get discounts on additional treatments.

Result? Patients commit to treatment, and you get consistent, predictable revenue.

Want to launch a membership plan today? Check out BoomCloudApps.com.


Step 4: Case Study – How One Dentist Scaled to $20K in Recurring Revenue Using BoomCloud

Dr. Sarah was sick of dealing with insurance & late payments.
She launched a membership program using BoomCloud.
Instead of billing insurance, she got paid directly by patients.
In 12 months, she had 600+ members paying $35/month.
That’s $21,000/month in predictable revenue (MRR).

Her membership patients spent 3X more on cosmetic & restorative treatments.

Want these results? Visit BoomCloudApps.com and start your membership program today!


Step 5: Free Resources – Get Payment Agreement Templates & Consent Forms

If you’re serious about getting paid on time & avoiding billing nightmares, you need the right tools.

FREE Consent Form Tools: BoomCloud Consent Form Tools
Membership Management Software: BoomCloudApps.com


Final Thoughts: How to Fix Your Dental Billing & Grow a Profitable Practice

If you want to eliminate billing stress & increase revenue, here’s what to do:

Use a solid payment agreement template so there’s no confusion.
Offer flexible payment options (pay-in-full, plans, memberships).
Set clear expectations for late payments & collections.
Launch a membership plan to create recurring revenue & patient loyalty.

Want to make billing EASY? Visit BoomCloudApps.com and start your membership plan today!

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Jordon Comstock

Author Bio

Jordon Comstock is the Founder & CEO of BoomCloud™, a software that allows practice, clinic & spa owners to build, manage and scale a membership program. This helps practice & clinic owners to create recurring revenue & improve loyalty via membership programs. Jordon is passionate about Music, Hawaii, Healthcare businesses like: dentistry, optometry, med spas and massage spas. Schedule a demo of BoomCloud™ and learn how membership programs can improve your business. Here are more dental books to improve your practice

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