Your medical information is important to us so that we can diagnose and treat your dental concerns completely. Every year we may ask you to update your medical history. This is important even if you haven't experienced any changes in your health. The update allows us to review your heath with you and evaluate it in the light of new dental treatments that may not have been available to you before.
If you have any medical changes, please let us know.
Also please inform us of any change in your name, address, phone number, marital status, employment or insurance coverage.
Notice of Privacy
The new HiPAA law has been passed to protect your privacy. We are very careful to keep any information you give us in confidence. We will not discuss your patient or financial records in front of other patients or with any persons other than those with whom you have authorized us to share the information.
Financial Policy
We have made and will continue to make every effort to keep down the cost of your dental care. Our policy is to request payment at the time of service. We try to avoid sending statements. The cost of paperwork, postage and manpower directly affects our fees.
We do our best to help our patients plan for the financial investment they are making in their dental care. Our treatment coordinators will work with you to arrange a treatment plan that fits your budget. We will be happy to discuss the procedures and fees before we schedule the next appointment.
Insurance
As a convenience to our patients who have dental insurance, our office will submit the charges to your insurance carrier. There is no fee for this service.
Please understand that your insurance is a contract between you and your insurance company. No insurance company covers all dental costs. It is your responsibility to pay any deductible amount, coinsurance, or any other balance not paid for by your insurance company. At the time of your treatment we will also ask that you pay an estimate of what your portion of the fee will be.
It usually takes two to four weeks for benefits to be paid. If after 45 days, the insurance company has not paid us, we will ask you to pay the balance of your account. We will continue to help you seek settlement from your insurance company, but it may be necessary for you to contact your insurance company if payment does not come promptly.
| Attachment | Size |
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| New Patient Forms | 3.42 MB |







