• Records and/or x-rays from previous dental providers
• Dental insurance card
• The co-payment required by your insurer – we take cash, check, and credit cards
• A list of the medications you take
Please arrive 10-15 minutes early to fill out necessary paper work. You can save time by
downloading the Patient Information, Medical History and HIPAA forms below. Print and fill out
the forms, and bring them with you to your first appointment.
Click the links below to download the following forms:
• Patient Information Form
• Medical History Form
• HIPAA Form
• Privacy Practices
• Financial Policy
We do accept x-rays from other dentists as long as they are of diagnostic quality and are current. Bitewing x-rays must have been taken within the past six months, and Panorex within the past five years. X-ray copies must not be too light or too dark. (Often the x-rays we receive from other offices are of poor quality.)
We do accept assignment of benefits from your dental insurance carrier. We will file your insurance for you, but you will be responsible for any co-payment required by your policy. Please note that we do not accept HMOs or PPOs.
For any services not covered by insurance, we offer flexible payment schedules and accept credit cards including Mastercard and VISA. For larger cases, we provide our patients with
financing options to ensure that they can get the dental services they require without
causing themselves significant financial hardship.
We strive to deliver the highest quality, cutting edge dentistry to our patients. We are dedicated to ensuring you get the dental services you require without causing you significant financial hardship.
As a service to you, we will file dental forms for you and will accept payment directly from insurance companies. Carol, our insurance specialist, will work with your insurance company to maximize your benefits. Your dental co-pay – the amount your insurance does not pay – is due on the day services are rendered.
For any services not covered by insurance, we have several standard payment options available, including cash, checks, Visa, and MasterCard. We ask that payment be made on the day services are rendered.
For larger cases, we offer financing options through CareCredit, including:
• Short-term, no-interest payment plans
• Convenient low-interest financing plans for payments over an extended period
There are no annual fees or prepayment penalties. The approval process is simple and can be done in the office.
(Please note: We do not accept HMOs or PPOs, and we charge $10 for returned checks.