New Patients

Identification

For your protection and privacy all patients are kindly asked to bring a photo ID with them: driver’s license or government issued ID.

Health History Questionnaire
We ask all patients to complete our health history form to provide us with as much of a complete overview of medical and dental health. Please answer all questions thoroughly and accurately and sign and date the form where indicated. If you take any medications and can provide us with a list prior to your visit, you will greatly assist our team.

DOWNLOAD THE QUESTIONNAIRE HERE (Please print and sign)

Dental Insurance

Please bring your current dental insurance card with you on your first visit as we are unable to process the claim without it. If there are any changes in coverages or companies, notify the office immediately. In most cases, dental insurance has an annual deductible and a specified percentage of coverage (of a company’s fee schedule.)

We participate in certain PPO plans which fall under:

• Connection Dental
• Delta Dental Premier
• MetLife Dental PPO Plus
• Maverest/Renaissance

We also accept and process traditional dental insurance (that is, the patient may go to any dental office.) We file all insurance claims electronically and work online as much as possible to assist our patients in making the most of their benefits. We also are happy to file insurance for those patients whose PPO is not on the above list, although we cannot confirm the exact amount of benefits to be expected. In this case, the patient pays at time of service and the insurance check is sent to them. For those individuals with dental HMO’s there will be NO coverage for your dental care if you come to our office as we unable to file HMO claims.

Financial Policy

Payment is expected at time of service unless otherwise agreed upon in advance. All patients are asked to read and sign the financial policy. Payment Options are: Cash, Checks, and Major Credit Cards: Visa, MC, Discover, AmEX. We also participate in CareCredit financing.

DOWNLOAD OUR FINANCIAL POLICY HERE (Please print and sign)

Notices of Privacy Policy

As required by law our office adheres to written policies and procedures to protect the privacy of information about you that we create, receive, or maintain. Your information is for our records alone and will be kept confidential subject to applicable laws.