The goal of this practice is to provide exceptional customer service and excellent dental care with both a professional and personal touch. The following policies are implemented so we can better serve you.
We have attached the information for your review. We will need for you to review the Financial Policy and Cancellation Policy Agreement carefully. This form must be filled out by our patients.
Please click on each of our forms so you can print out the necessary information that we will need for your visit.
If you have any questions regarding any of the forms and/or policies, please contact our friendly staff and we will be more than happy to answer any questions you may have.
This agreement covers your Payment options, Patient Responsibility, and Assignment and release. In addition, it explains our cancellation policies. We understand that schedules can become uncontrollable at times, therefore, please read this section carefully. This form requires your signature for our records.
This form covers all of your account information, including patient profile, Dental Insurance coverage, and emergency contact information. This form requires your signature for our records.
In order to better serve and protect you, we must be aware of any current and prior health conditions you may have had. Please read through carefully before signing.
We need your basic dental history on file. In addition, if there are any other conditions that we must know, there is an area to describe your conditions.
This notice describes how health information about you may be used and disclosed and how you can get access to this information. The privacy of your health is important to us.
