New Patient Forms
Our New Patient Packet includes three forms that will need to be completed before your first visit. Please complete each form by clicking on the link below, downloading the document, and then filling it out. You can either bring them in with you or scan/email them to us at [email protected].
We are eager to assist you in obtaining the maximum benefits from your dental insurance company. The amount that is covered by your dental insurance depends entirely on your specific dental plan. As a courtesy, we are happy to submit pre-authorizations for treatment to your insurance company.
To better assist you, please bring your insurance card to your first visit.
Payment & Financial Agreement
It is our goal for patients to clearly understand their treatment needs, as well as their financial responsibility before treatment begins. It is our desire to make dental treatment affordable to all of our patients. We offer the following financial arrangements:
We accept some dental insurance, credit cards, checks and cash.
Credit cards accepted: VISA, MasterCard, Discover
5% Cash Discount for cash and/or check payments made in full at the time of treatment.
Patients with Insurance: the estimated portion that is not covered by your insurance is due at the time of treatment.
Patients without Insurance: Payment for dental services are due at the time of treatment.
If you have any questions, please let us know and we will be more than happy to assist you.
We make every attempt to safeguard your health information. We understand the importance of keeping your information confidential and value having a mutually trusting relationship. Please download and review our HIPPA notice.