Please download the following forms
and complete them prior to arriving for your first visit.
New Patient Form
Consent Form
Privacy Notice
Financial Agreement
Payment Options
Financial constraints should never prevent necessary dental care. We work with
our patients on financial arrangements to make sure your treatment plan works
within your financial budget. Our office team will carefully discuss all your
options.
Option #1
Payment in Full at each
appointment
Payment by cash, personal check, Visa, Master Card, or Discover at treatment
appointment
Option #2
Prepayment Discount
A 5% discount is offered for prepayments made in full. This must be paid with cash or
personal check prior to the first treatment visit. Insurance benefits will be paid to
you.
Option #3
Insurance Assignment of Benefits
Our team will work hard for you to receive the greatest benefit from any
insurance plan you may have. We do
require that your deductible and percentage be paid at the time of service. We accept assignment of benefits on
most PPO insurance plans.
Option #4
Extended Financing
You can finance your treatment with Care
Credit, a finance company
available through our office. We
supply the necessary forms and help you with the application process or you can
apply online.
To successfully complete the application, you will need the following
information :
·
Social Security number
·
Date of birth
·
Employment information, including income
Our application only takes a few minutes to complete. Once you submit your application, you
may receive a decision within seconds.
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