Patient Forms

Save time; fill out these forms before you come in to see us

You’ll be able to save time by downloading our New Patient Paperwork PDFs, filling them out, and bringing them to your first appointment. If you are a New Patient, download either the Adult or Children’s PDFs to your computer and print them out. Also download the Other Forms (#3) and print them out as well.

hhxThis standard questionnaire from the American Dental Association is meant to provide your dentist with important information about your overall health and help make your dental care safer and more comfortable.

Please fill out both pages and bring to your first appointment.
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childsformThis standard questionnaire from the American Dental Association is meant to provide your dentist with important information about your child’s overall health and help make your child’s dental care safer and more comfortable.
Please fill out and bring to your child’s first appointment.
Download >
 slformThis combination PDF contains several forms and documents that new patients are required by law to read and sign.
Pages 1-2: Notice of Privacy Practices: Please review
Pages 3-6: Facts About Fillings: Please review
Page 7: Authorization and Informed Consent for Treatment: Please read and Sign
Page 8: Acknowledgement of Receipt: Please Sign
Please bring all of your signed pages to your first appointment.
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Policies | Financial | Insurance

Helpful Information

We look forward to serving your dental needs and working with you to improve both your dental and overall health.

We hope the information below will be helpful as you become a valued patient in our practice.
If at any time you have any questions don’t hesitate to call our office. We appreciate your business and are more than willing to work with your individual account and customize a payment plan for you. We realize that dental work can be a large and sometimes unexpected expense. Please also take a moment to review our policies too. Thanks

What is typical reimbursement for dental procedures?
Typical % of Reimbursement are as follows:

  • Preventive Procedures 100% (cleaning, exams, x-rays)
  • Basic Procedures 80% (fillings)
  • Major Procedures 50% (crowns, bridges etc.)

Are there dollar limits to what my insurance will cover?
Most companies have an annual maximum of $1000-2000 a year. This means they will only pay out that much in benefits for the year (including your routine cleanings) and the rest of the expenses are out of pocket. Most policies also have a $50-100 deductible that is waved for preventive procedures, but applied on basic and major procedures.

Are there time limits to what my insurance will cover?
Frequency of Benefits: Most insurance companies will pay for 2 cleanings a year, one set of bitewing x-rays and an exam. They will also include a full mouth series of x-rays every 3-5 years. Other benefits depend on your individual plan.

carecreditOur office accepts Visa, Mastercard, AMX, money orders, cash and personal checks. In addition to these payment methods we offer a no-interest financing plan for through Care Credit.  We realize dental fees can be expensive and our office is happy to help you with payment plans, insurance questions etc.