Patient Information

 

Patient Forms

If you are a new patient to our office, the forms below will need to filled out when you arrive for your first appointment in our dental office. Printing them, filling them out and bringing them with you will allow us to attend to your dental needs more quickly than completing them on your arrival.  Thank you and please call our dental office if you have any questions or need any assistance. 


New Patient Registration Form (coming soon)

Patient Registration Form (coming soon) 

HIPAA Privacy Act (coming soon)

This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

 

Payment Options

For your convenience, we accept cash, personal checks, money orders and major credit cards including, VISA , MasterCard , American Express.  Payment is expected at the time services are performed. When more extensive dental care is necessary, financial arrangements can be made with our office.  

  
Dental Coverage 

As a service to our patients, our practice accepts most dental coverage programs, including non-managed care and indemnity (traditional).  We are not part of any managed care network.  Our accounting staff will prepare all the necessary forms for your dental benefits. However, we remind you that your specific policy is an agreement between you and your carrier. Please keep in mind that you are responsible for your total obligation should your benefits result in less coverage than anticipated. Our staff will gladly submit a pre-treatment estimate to your carrier so that you will know what your benefits will be.

The fees charged for services rendered to those who are insured are the usual and customary fees charged to all our patients for similar services. Your policy may base its allowances on a fixed fee schedule, which may or may not coincide with our usual fees. You should be aware that different carriers vary greatly in the types of coverage available. Also, some companies take care of claims promptly while others delay payment for several months. 

 

 We accept Kleer and CareCredit financing


 

 


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