Pay Your Bill

Michael S. Leonard, D.D.S.
Jeremy M. Zaluski, D.D.S.

We strive to provide excellent care in a relaxed atmosphere.

Patient Resources


Payments

Online Bill Pay

We accept all major credit and debit cards for online payments.

To make a payment online, click the link below:

Pay Your Bill Online

CareCredit

We proudly accept the CareCredit credit card to help you finance your healthcare needs. Now you can pay online with CareCredit at the time of care, when you get a post-care bill, or up to 30 days before your appointment, quickly and securely. Special financing options are available.

Apply/Pay Online with CareCredit

Financial Options

We accept all major credit cards, checks, and cash payments. We also participate with CareCredit to offer 0% interest financing for larger balances.

Payments can be made on our website, by calling our office, by texting our office for a text-to-pay link, or by mail.

Online Forms

Save time in the office by completing forms online prior to your upcoming appointment!

Online forms open in a separate window and do not require you to create an account or download any software to complete them. Be sure to click “submit” when done to send the completed form back to our office. You can also request a form link to be texted or emailed to you directly by calling or texting our office at (269)488-4500.

Paper forms are available for those who do not wish to complete forms online. If you prefer paper forms, please arrive at least 15 minutes early to your scheduled appointment to complete forms in the office.

New Patient Forms

New/Returning Patient Bundle
  • Includes Medical History, Patient Registration, Office Policies, and HIPAA forms
Records Release Request
  • Authorize our office to request your dental record FROM a previous dentist or other health care provider.

Current Patient Forms

Medical History Update Form
  • We request patients update their medical history with our office whenever there are changes, or once every 2 years at minimum.
Dental Insurance Update Form
Dental Records Release Authorization
  • Authorize our office to release your dental record TO another office

HIPAA and Privacy

Authorization Form for Use or Disclosure of Patient Information

  • Use this form if desired to authorize other individuals (partner, parent, child, etc.) to have access to your patient information and to specify what information may be disclosed.

Notice of Privacy Practices

Acknowledgement of Receipt of Notice of Privacy Practices

Surgical Forms and Instructions

Save time in the office by completing forms online prior to your upcoming appointment!

Online forms open in a separate window and do not require you to create an account or download any software to complete them. Be sure to click “submit” when done to send the completed form back to our office. You can also request a form link to be texted or emailed to you directly by calling or texting our office at (269)488-4500.

Paper forms are available for those who do not wish to complete forms online. If you prefer paper forms, please arrive at least 15 minutes early to your scheduled appointment to complete forms in the office.

Pre-OP Instructions

  • Before IV Sedation

    • Consent Forms

  • Extraction Consent Form
  • IV Sedation + Treatment Consent Form
  • Dental Implants Consent Form
  • Complete Denture Final Processing

    • Post-OP Instructions

  • After Tooth Extraction
  • After the Removal of Multiple Teeth
  • After Wisdom Tooth Removal
  • After Placement of Dental Implants
  • Post-Op Instructions for Dentures

    • Office Policies

    Confirmation Policy

    We must receive confirmation from the patient or their representative by 2pm the business day before all scheduled appointments.

    Unconfirmed appointments may be canceled and rescheduled by our office.

    If we choose to cancel an unconfirmed appointment, we will attempt to notify the patient or patient representative via the contact information we have available.

    Cancelation Policy

    There will be a fee of $25.00 assessed for all no-show appointments.

    Appointments canceled less than 24 hours in advance may be subject to a $25.00 fee, at the discretion of the front office staff.

    Multiple no-shows or last-minute cancelations may result in dismissal form our practice.

    Financial Policy

    ayment for services is due at the time of service unless prior arrangements have been made.

    Unconfirmed appointments may be canceled and rescheduled by our office.

    If we choose to cancel an unconfirmed appointment, we will attempt to notify the patient or patient representative via the contact information we have available.

    View/Download Full Office Policies

    Privacy Practices

    Notice of Privacy Practices

    We are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information.

    You can view our full Notice of Privacy Practices by clicking the link below. You may download or print this form, or a paper copy can be requested at by contacting our office.

    View/Download/Print Notice of Privacy Practices PDF

    Authorizations for Use or Disclosure

    To authorize the use or disclosure of your protected health information, and to specify what information may be shared, please fill out the following Authorization Form.

    Authorization Form for Use or Disclosure of Patient Information

    Questions and Complaints

    If you want more information about our privacy practices or have questions or concerns, please contact us.



    Contact Us

    7120 Stadium Drive
    Kalamazoo, MI 49009

    Call/Text: (269)488-5400

    Fax: (269)488-3137

    Office Hours

    Monday to Thursday
    8:00 am to 5:00 pm

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