New Patient Forms Financial Policies Medications X-Rays Contact Information Location and Directions
Prior to your appointment, fill out the Patient Intake Form. Your patient form includes all demographic information, health history, and HIPPA. Our office staff can give you copies of these patient forms to fill out when you arrive. However, it is preferred you print and complete them before coming to your initial visit.
Click on the name of each form below to open:
Consent for Dental Implant Removal
Financial Policies
Our office accepts cash, check, or credit cards: VISA, MasterCard, Discover, and American Express. Payment is due at the time of service; however, patients with more extensive treatment plans are also willing to work with patients to make their treatment affordable.
WE DO NOT ACCEPT CARE CREDIT
We are a Fee for Service practice. Meaning we are NOT in-network with any insurances. We are happy to submit insurance claims on your behalf, but we do not guarantee payment.
Here’s what the reasoning behind fee-for-service really is, and how it can benefit the care you receive.
Working outside of the network/ fee for service allows us to charge a fair and fixed rate for specific procedures that we offer, rather than have our fees managed and dictated by a third-party insurance provider. This measure allows us to utilize the highest quality lab and material rather than selecting lower-quality facilities to meet cost restrictions. As a result, you receive excellent care unrestricted by an insurance carrier’s contract.
Payment at the Time of Service:
As a Fee for Service Dentist, we may request payment one of two ways:
- You pay in full at the time of treatment, which is preferred.
- We collect half of your treatment cost and submit to your insurance. Any remaining balances not covered or paid by your insurance benefits after the claims have been processed are 100% the your responsibility.
Either way, you the same amount.
It’s important to note that insurance claims can take over 30-90 days or more to file and process.
An Advantage for Patients and Dentists:
Fee-for-service dentistry is a deterrent for some patients when searching for a new dentist. But the truth is, when you need the best care at a fair rate, seeking out a fee-for-service dentist provides you and your dentist with more freedom concerning what’s possible for your smile. Fair pricing allows your dentist to select the best treatment and procedures, rather than the ones that are “only covered by insurance.”
Moreover, you can feel confident selecting one of our highly-trained providers.
Medications
We ask that you bring a current list of any medications (with dosages) that you are taking.
X-Rays
If you have dental x-rays taken within the last two years, it would be beneficial to bring them with you to your initial consultation appointment.
Contact Information
Should you have a particularly complex medical history or a long list of medications, please bring the contact information for your medical doctors.
If your referral is from another dentist, please bring it with you. If you do not have a referral form, please bring the contact information of the most recent dentist you have seen.
Please bring your dental insurance cards with you to your appointment.