NEW PATIENT FORMS
If you are a new patient to our office, the attached file contains our new patient forms that will need to be filled out when you arrive at our office. Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival. Thank you and please call our office if you have any questions at all. (Please click the "patient forms" link below to open the forms)
As a new patient, your first appointment will consist of an initial comprehensive exam, bitewing x-rays, and a panoramic film performed by our dental professionals. If you are diagnosed with a healthy mouth, you will then be scheduled for a cleaning.
Adult Registration Forms
Children's Registration Forms
Consent for Treatment Form
Privacy Practices Policy
Dental & Medical History Forms
This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.
For your convenience, we accept cash, personal checks, money orders and major credit cards (Visa, Mastercard, American Express and Discover). Payment is expected at the time services are performed. When more extensive dental care is necessary, financial arrangements can be made with our office.
Care Credit www.carecredit.com
As a service to our patients, our practice accepts and bills most dental insurance programs, including non-managed care, indemnity (traditional) and PPO out-of-network. We are participating providers with Delta Dental of Michigan. Please contact your HR or insurance company directly to verify coverage and participation. Our staff will prepare all the necessary forms for your dental benefits. However, we remind you that your specific policy is an agreement between you and your insurance company. Please keep in mind that you are responsible for your total obligation should your insurance benefits result in less coverage than anticipated. Our business team will gladly submit a pre-treatment estimate to your insurance company so that you will know what your benefits will be.
The fees charged for services rendered to those who are insured are the usual and customary fees charged to all our patients for similar services. Your policy may base its allowances on a fixed fee schedule, which may or may not coincide with our usual fees. You should be aware that different insurance companies vary greatly in the types of coverage available. Also, some companies take care of claims promptly while others delay payment for several months.