Forms & Payment

Appointments

We recognize how valuable your time is.  We will do our best to see you at the time of your appointment.  On occasion, we have patients who call with emergencies.  We treat patients in pain as emergencies and appreciate your understanding in these circumstances.  If you are unable to keep your scheduled appointment, we must have a minimum of two business days' notice in order to allow another patient to use the time that has been set aside for you.  Failure to let us know of your cancellation a minimum of two business days in advance could result in a charge of $50.00 per hour.  We appreciate your consideration regarding this appointment policy.

Insurance

If you have insurance, please let us know.  Carriers vary, but we will try to help you get the most benefit out of your particular policy.  We will be happy to prepare a claim and mail it to the Benefit Company on your behalf.  PLEASE KEEP IN MIND THAT YOU ARE RESPONSIBLE FOR YOUR TOTAL OBLIGATION SHOULD YOUR INSURANCE BENEFITS RESULT IN LESS COVERAGE THAN ANTICIPATED.  We do ask that you pay you estimated portion at each visit.  Payments by some insurance companies will be mailed directly to you.

Some insurance companies require a dentist to join their plan in order to receive assignment of benefits. We have chosen not to join any of these plans.  Our mission is to provide the best possible treatment for each patient without interference from a 3rd party.  We will accept assignment of benefits if your insurance plan allows it.

If you do not understand your insurance benefits, it is best that you ask your HR Department or Insurance Representative. Otherwise, bring your insurance booklet with you and we will try to help you.

Payment At The Time Services Are Rendered

We request that patients pay for services when they are rendered.  We accept cash, personal checks, Master Card, Visa, American Express, and Discover.  For extended payment options, please ask us for an application for the Dental Fee Plan, a low interest rate plan offering financing for up to 48 months.

Forms

The forms below must be completed before we can commence treatment.  If you'd like to save some time when you come for your initial visit, you can click on the links below, and the forms will open up in a new window, where you can print them, fill them out, then bring them with you.

If you are unable to open the above documents, please download the latest version of Adobe Acrobat Reader by clicking here.