Patient Forms

We have made our patient forms available to you as .doc files. For your convenience, we recommend printing and completing these forms at home. Please remember to bring your completed forms with you for your first appointment. If you have any problem getting these files to print properly, please call our office and we will gladly send or fax them to you.

FINANCIAL ARRANGEMENTS

CASH/CHECK/CREDIT CARDS All payments are due the day of service unless previous arrangements are made. For services requiring more than one appointment, 50% of the fee is due at the first appointment and the balance must be paid in full by the final appointment. We accept Visa and MasterCard to allow you the convenience of paying by credit card. DENTAL INSURANCE As a service to our patients, we file your insurance claims for you. We accept all dental insurance plans but are not a participating provider for any specific plan. It is the patient’s responsibility to provide correct insurance information at the first appointment. We will work to estimate your coverage and co-pays as accurately as possible; however, you are responsible for all costs not paid by your insurance company. All co-pays are due on the day of service. PAYMENT PLANS We have partnered with CareCredit and ProFinance to help you finance your dental work. This allows you to complete the work without delay and make small monthly payments to either company. They offer little or no interest payment plans from six months to five years in length. You may obtain more information or apply at the office. You can also apply for CareCredit online at www.carecredit.com

HIPAA and Consent Form

Medical History

Notice of Privacy Practices

Patient Registration Form

Post Op Instructions

Teeth Whitening Instructions