New Patient Information

Getting Started As A New Patient In Our Office!

Congratulations and welcome to our practice. We are very excited that you have chosen to be part of our dental family. Please fill out all forms below and bring them with you to your first dental appointment.

If you are transferring from another office please fill out the form that is for x-ray transfer authorization and send this to your previous dental office so they can submit any and all x-rays that they may have on file; x-rays older then 1 year will be obsolete; if they are bitewings. However, if your previous dentist has a panoramic film or full mouth series on file; we will accept this x-ray because it is good for 3 years.

Now you can fill out all necessary forms prior to your visit online!  

Also, if you are a registered patient please login prior to your scheduled appointment and update your medical form.

Simply Click the Appropriate Link Below

EXISTING PATIENT LOGIN

NEW PATIENT FORMS

If you prefer to have a paper form please fill out the forms below and bring them with you to your scheduled appointment, Thank you.

Patient Information Form

Medical History Forms

Record Transfer Form

Financial Policy

HIPAA Release Form


Notice Of Privacy Practices
 – New revised version of the  HIPAA laws please make a copy for your personal records

Insurance Companies We are Affiliated with.

BCBS

Cigna (Radius Group)

United Healthcare

Dentemax Group (over 150 plans) Lincoln Financial, ACS Benefits, Coventry Dental, Companion Life, Humana Dental, Prudential, Sun Life Financial and more.

In addition, we will file any and all insurance plans that we are not contracted with; as long as it is a PPO Plan. If you have any questions about your coverage please contact your plan specifically, as we are only advocates in helping you maximize your benefits and insure proper payment.

Also, because your smile is important to us, we offer CareCredit payment plan options. CareCredit is a health credit card specifically designed to pay for treatment and procedures that are either not covered by insurance or are only covered at a percentage. Please visit www.carecredit.com and fill out your application today.

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