Patient Registration Form (Acrobat PDF form)

Medical History Form (Acrobat PDF form)

Office Finance Policy (Acrobat PDF form)

Authorization for Release of Identifying Health Information (Acrobat PDF form)

Acknowledgement of Receipt of Notice of Privacy Practices (Acrobat PDF form)

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Financial Options

Payment Options

Our office operates on a "fee-for-service" basis. That means that payment is expected at the time of service. For extensive treatment needs, we offer financing through an independent company. All fees for treatment will be discussed at the time of the new patient examination and consultation. Our staff is always helpful in processing your dental insurance for reimbursement once payment has been made. We accept VISA, MasterCard, cash and Personal Checks.

There is a $25 service charge for any returned personal checks

Insurance

Our office has always been happy to work with patients covered by dental insurance. We think insurance is a great incentive to maintain a vital level of dental health. We are considered as an "in network provider" for most PPO plans. We do not accept HMOs. We're happy to help you with any insurance questions you have. We'll even go over your policy with you, try to maximize your benefits, and request a predetermination of benefits to let you know what your insurer will pay. However, please keep in mind you are responsible for your total obligation should your insurance benefits result in less coverage than anticipated. We do ask that you pay your portion at each visit unless other arrangements have been made.

Co-payments and deductible payments are designed by insurance companies to enhance patient responsibility and commitment to their own dental care. Therefore, we require that patients with insurance pay the co-payments and deductibles at the time of service
Thank you for placing your trust in us to provide your dental care! We look forward to a happy, healthy and affordable smile for you, your family and friends.

Our office understands the value of insurance benefits to our patients. We will fill out and file your insurance forms at no charge. We will estimate your deductible and the portion that we feel will be covered by your insurance carrier. We will do all we can to assure you of maximum benefits. There are no guarantees however, and payment for dental service is due regardless of the benefits paid by your insurance and is the patient's responsibility.

It is our philosophy that dental insurance coverage is an agreement between the patient and the patient's insurance company. Please remember that you are ultimately financially responsible for the dental treatment provided. Patients are expected to pay for treatment the time of service.
In an effort to facilitate dental treatment, our staff is happy to help with pre-treatment estimates and the processing of all dental insurance claims. Your insurance company will then reimburse you directly after payment has been made. Our staff is also there to answer insurance questions that may arise during the course of treatment.

We do not accept secondary insurance in this office.

Hours of Operation

Monday - Thursday 9:00am - 5:30pm
Friday 9:00am - 3:00pm

Saturday by Appointment Only