Forms
NEW PATIENT FORMS
Please take a moment to download and fill out your new patient forms. This will make our time together more efficient for you.
Click here for the New Patient Packet
Included in the packet is our HIPAA consent form. We respect your privacy and realize that you are placing a great deal of trust in us. There are times when it is important for us to discuss your medical history with other medical professions. This form gives us permission to do just that, discuss with other professionals, and NO ONE else!
The next form is our Health History Survey. Please answer as honestly as possible as this information is important to us. The more we know, the better and safer we can treat you! Our office does not discriminate based on any information on this form. We use it only for formulating safe treatment for you! This form is two pages.
The last form is our Cancer Screening form. We use a new technology in our office, the Identifi 3000®. Although it is not always covered by insurance, it is one of the most sensitive tests on the market. We are dedicated to the early detection and treatment for our patients. Please feel free to discuss this with us, the choice is yours.
In order to view the forms and download them you will need Adobe Acrobat Reader, click here if you do not have this free program.
Click here for the New Patient Packet
CARE CREDIT
Whether you have dental insurance or not, many services are not covered. CareCredit is a credit card exclusive for healthcare services. With no up-front costs, no pre-payment penalties, and no annual fees, CareCredit lets you pay over time and frees up cash and credit cards for the other things you want or need. CareCredit offers low monthly payment plans for healthcare procedures not commonly covered by insurance, including dental treatment. Plus, you can use your card again and again to pay for additional treatment for yourself or family members in any CareCredit practice.This means you don’t have to put your health and beauty on hold until you save up enough money. We give you the power to decide when it’s the right time for you!
• Low minimum monthly payments
• No-interest financing if paid within 12 months (Additional plans may be available)
• No up-front costs, pre-payment penalties or annual fees
Learn more by visiting CareCredit.com or contacting our office.
Ready to apply? Apply online for your CareCredit card today.
