Patient Forms

If you are a new patient to our office, the attached files contain our new patient bundle with forms that will need to be filled out when you arrive at our office.  Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all.

Patient Registration

Health History

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Insuance Policy

Our office accepts many Premier and PPO insurance plans. These plans provide you with the ability to choose a dentist of your choice. We do not accept Medi-Care, MediCaid or any HMO/DMO plans. HMO and DMO plans do not allow you to choose any dentist. They assign you to a contracted dentist. If you have a HMO or DMO plan and would still like to be seen in our office, we will still be more than happy to help you in any way possible.

Examples of benefit plans we work with include: Delta Dental, Aetna, MetLife, Guardian, Principal, United Healthcare, United Concordia and many more. Each plan is different and often dental benefits can be confusing and difficult to understand. If you are unsure if we accept your insurance or have any further questions regarding your benefits, do not hesitate to contact our office.

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Financial Policy

If you have insurance there is a unique contract between you, your employer and your insurance company. Not all services are covered at 100% by all insurance plans and the percentage of coverage varies based on the contracted benefit your company has established. We will bill your insurance for the services performed and we will collect your estimated patient portion at the time service are rendered. If you do not have insurance, payments need to be made at the time of service unless other arrangements have been made. For your convenience we accept Cash, Checks and most major credit cards. Our office also offers payment plans. If you are interested please contact our office for more information.