New patients, please download and print the following forms to fill out prior to your first dental appointment. Please bring them with you along with your previous dental records and x-rays to that scheduled appointment.
» Patient Registration Form
» Personal Needs Survey
» Medical History Form
» Privacy Form
Patients with dental insurance:
We are pleased that you have a dental insurance policy. We will do everything we can to help you maximize your benefits on an annual basis. We ask you to keep several important facts in mind:
• You have a maximum coverage per year of $1000, $1500 or $2000. When dental co-payment plans began in 1970, they allowed the same amount of maximum payment per year as allowed today!
• We ask that you understand, we neither work for the insurance companies, nor do we wish to. We work 100% for YOU. We want to help you maximize your benefits, but also we do not want to be controlled by neither insurance companies nor the benefit package they offer.
• Our office does not diagnose, render treatment or establish fees according to any insurance tables or allowances. Office fees are based on care, skill and judgement of the professionals delivering the services, and by the cost of operating a dental office dedicated to excellence. Most importantly, remember that we work 100% for YOU, not the insurance company. As a courtesy to you, we will file insurance claims. However, it is required that your estimated portion be paid at the time services are rendered.
We have three policies that we feel are important to share with our patients. We strongly believe in our work and professional efforts and we therefore ask you to read this information thoroughly and become familiar with these policies. If you should have questions regarding them, please call us.
Commitment to Treatment Policy
It is our firm belief that all patients who come to our office want and deserve the best dental care that can be provided. We believe all treatment begun should be completed. Incomplete treatment leads to problems, complications, misunderstandings, and usually futher disease. Therefore, if a plan is agreed upon and started, it needs to be completed. We will never move forward with treatment without your permission or consent.
Commitment to Appointment Policy
An appointment in our schedule is a bond of trust that we will be here to serve you and you will be present for treatment. Our office policy is firm in this regard,as we find it very hard to provide optimal dental treatment when faced with frequent cancellations or constant short-notice changes. When you show up for your appointment, we do our best to respect your time and see you at the appointed time.
Commitment to Financial Arrangement Policy
We believe we have the responsibility to use the best professional care, skill and judgement in planning and delivering your dental treatment. Your payment will reimburse us for our services. Payment is due at the time professional services are provided unless other financial arrangements have been made in advance with our office. Any type of financial arrangements made with our business coordinator are expected to be honored and followed through. No business or practice can fulfill its mission to its patients when a bond of trust is violated by failure to pay for services. Below is a composite outline of choices for financial arrangements:
• Cash, Check, Visa/Mastercard/Discover/Amex at the date of service
• Care Credit: A revolving credit line that finances up to 12 months interest free or longer with a fixed interest percentage. Ask our financial coordinator for an application or visit them online at www.carecredit.com.
• Full pre-payment prior to the date of service discount of 5% by cash or check.