Medical Forms

We have attached the following forms that can be printed and completed at your convenience before your first visit.

Patient Information Form & Consent For Treatment Form

Dental & Medical History Forms

Financial Policy and Insurance

Payment for services is due at the time dental treatment is provided.  Our office accepts cash, personal checks, debit cards, VISA, Discover, or MasterCard and CareCredit.

If we received all of your insurance information on the day of the appointment, we will be happy to file your claim for you.  We accept most PPO insurance plans and are an in-network provider with United Concordia (we do not participate with all United Concordia plans, please check on their web site to be sure your insurances plan is one that we participate with.), Met Life, Blue Cross Dental, Delta, Cigna and many others.  We will bill insurance companies for the services and not collect payment the day of service as long as they will send payment to our office.  Any amount not covered by your insurance due to co-pays, deductibles, etc. will be billed to you.  If you have questions about anything regarding your insurance or payment information please do not hesitate to call.  We will be happy to answer your questions.

We can also provide you with information about CareCredit enrollment.

(Click on the photo for more information.)