Home  |   Patient Forms  |   Location  |   Meet Dr. Lenz  |   Meet Dr. Paulsen  |   Meet the Team  |   Contact Us

Patient Forms - Financial Policy

Click on the link below to view the Financial Policy.

Financial Policy Form (pdf)

After reading the Financial Policy, you may digitally sign the form by entering your name and date below. Otherwise, you may sign the form when you arrive for your appointment.

By typing your name in the space provided below, this serves as your digital signature which affirms you have read and understand the financial policy and agree to its terms. If you have insurance, you also direct your insurance carrier to issue payment directly to Lenz Family Dental.

Signature of Patient (Please type your full name): Signature is Required.


14221 Metcalf Ave
Suite 100
Overland Park, Kansas 66223

Phone: 913.851.5900
Fax: 913.851.5912

Email: info@lenzdds.com

Click here for a map and directions

Click here to Refer A Friend

Our Hours

First Friday
of each month
8:00 a.m. - 5:00 p.m.
8:00 a.m. - 5:00 p.m.
8:00 a.m. - 5:00 p.m.
7:00 a.m. - 4:00 p.m.
7:00 a.m. - 2:00 p.m.
© Copyright 2010- Dr. Matthew T. Lenz DDS and www.lenzdds.com
All Rights Reserved
Web Development, Hosting and Maintenance provided by TakeCareOfMyWebSite.com