Forms

To make your office visit as quick and easy as possible, you can fill out the forms below prior to your visit. If you wish to fill out the forms electronically, please save each document to your hard drive, then open the document from your hard drive prior to filling out the forms.  We encourage you to scan back the form to us IF this can be encrypted, or use our private patient portal. Please call us and one of our team members will be happy to assist you!

Health History Form

HIPAA Compliance Form

INSURANCE AND FINANCING

We are more than happy to submit all insurance claims (including out-of-network!) for you, and help you receive the most coverage available from your insurance benefits.  We will do everything we can to help you afford the treatment you need and want.   Forms of payment accepted by the office are check, cash, and most major credit cards.

Once the patient has a full understanding of the clinical needs to accomplish complete oral health, the patient concierge goes over the full investment fee, and any dental insurance estimates. Our goal is to make the process as easy as possible for our patients by assisting with submitting all information needed by their insurance plans.

We accept and are able to process most dental plans. Due to the uniqueness of each plan, the patient concierge will explain the steps for your particular plan.

CANCELLATIONS

If you are unable to keep an appointment, we ask that you kindly provide us with at least 48-hours notice.  Some patients have to wait several weeks for an appointment, and would greatly appreciate your appointment time. A fee may be charged if a patient does not show up for an appointment without sufficient notice.