Forms & Finance
Below are Patient Forms that you can download, print and bring with you to your appointment. Please give us a call if you have any questions regarding these forms.
All forms are available in Adobe PDF format to ensure security. If you do not have the Adobe Reader, you can download it for free here.
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New Patient Forms: |
Additional Forms: |
Financial Policy
Payment is expected at the time services are performed. We accept cash, check, Visa, MasterCard. When extensive dental care is necessary or when dental insurance is involved, financial arrangements can be made with our office manager. Please inquire about our financing plans. Our primary concern is your dental health. Nevertheless, we will be sensitive to your financial circumstances within the framework of sound business practices.
Dental Insurance
Our accounting department will prepare all of the necessary forms for this important benefit. However, we remind you that your policy is an agreement between you and your insurance company, not between your insurance company and our office. We can make no guarantee of any estimated coverage, but we promise to do our best to see that you receive your maximum benefits. Please keep in mind that you are responsible for your total obligation should your insurance benefits result in less coverage that anticipated. If you would like to know what your expected coverage will be, we will submit a pre-treatment estimation to your insurance. It usually takes 2-4 weeks to receive a detailed response from the insurer.
Cosmetic Dentistry and Insurance
Cosmetic procedures are generally not covered by most dental insurance policies; however, partial benefits are often available if the teeth are broken or have previous dental fillings, bonding, or crowns. Also, most insurance companies will pay approximately 80% of the cost for silver fillings on posterior teeth (molars and bicuspids). If a more expensive porcelain or composite (tooth colored) filling material is used, the insurance company often will pay their percentage based on the cost of the less expensive silver filling.
