Information for New Patients

Commitment to Treatment

We believe all treatment begun should be completed. Incomplete treatment leads to problems, complications, misunderstandings, and usually further disease. Therefore, if a plan is agreed upon and started, it needs to be completed.

Commitment to Appointments

An appointment in our schedule is a bond of trust that we will be here to serve you and you will be present for treatment. Should you need to change or cancel an appointment, we ask the consideration of 48 hours notice. Our office policy is firm in this regard and we will not tolerate frequent cancellations or constant short-notice changes. A $50.00 to $100.00 fee may be assessed for missed appointments. No future appointments will be scheduled for patients who abuse this policy.

Commitment to Financial Obligation or Responsibility

We believe we have the responsibility to use the best professional care, skill, and judgment in planning and delivering your dental treatment. Your payment will reimburse us for our services. After all fees are properly explained to you, you agree to fulfill your financial commitment to our office promptly and completely.

Our financial policy requires that cash, check or credit card be used for all visits. We ask that you pay in full the day your services are rendered. On certain extensive procedures and treatment, payment plans can be arranged through Care Credit Financing. Accounts over 90 days will be assessed interest.

Patients with Dental Insurance

We are pleased that you have dental co-payment insurance. We will do everything we can to help you maximize your benefits on a yearly basis. We now accept Cigna Dental, Blue Cross and Blue Shield. We ask you to keep several important facts in mind:

1. You may have a maximum coverage per year of $500.00 to $1,500.00. When dental co-payment plans began in 1970 they allowed the same amount of maximum payment per year as allowed today. In other words, reflecting for a 6% per year inflation, your $1,000.00 benefit per year is approximately $250.00 in today's dollars. Had various dental insurance companies increased their benefit on a year by year basis reflecting increases for inflation, this year your benefit would be approximately $3,500.00 per year!!
2. We ask that you understand that we neither work for the insurance companies, nor do we wish to. We work 100% for you. We want to help you maximize your benefits. We also do not want to be controlled by insurance companies nor the benefit packages they offer. Normally, in our office, you can count on your insurance company paying 25-60% of the total fee for services provided in a high quality private practice such as ours. Your insurance is a contract between you, your employer, and the insurance company. We are not a party to that contract. Our fees are generally considered to fall within the acceptable range by most companies, and therefore are covered up to the maximum allowance determined by each carrier. This applies only to companies who pay a percentage (such as 50%, 80%) of "U.C.R.". "U.C.R." is defined as usual, customary and reasonable fees for this region. Thus, our fees are considered usual, customary, and reasonable by most companies. This statement does not apply to companies who reimburse based on an arbitrary "schedule" of fees which bear no relationship to the current standard and cost of care in this area. Not all services are a covered benefit in all contracts. Some insurance companies arbitrarily select certain services they will not cover.
3. Lastly, we believe that a cooperative effort between you and our office will result in a dental service that we are proud to render and you are pleased to receive. We want to meet your needs in a way that adds significant value to your life and ours as well.

New Patients Forms

In this section, you can download the forms that are very important, our medical history form and our dental history form. Our privacy practices will print out with the medical history form. By signing the medical history form you are agreeing that you have received a copy of our privacy practices. Before your first visit, please take the time necessary to accurately fill them out. We suggest this be done when you are not rushed and can candidly reveal any past fears, disappointments or problems you may have experienced in dentistry. The more we know about you the better we'll be able to serve you.

Dental Questionnaire

Medical Questionnaire

Privacy Practices

Neuro Epworth Scale

We also offer the following payment options for our patients:

• Cash
• Debit
• Check
• VISA
• MasterCard
• CareCredit