Forms / Payment

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Forms

The New Patient form is in PDF format, which can be read using Adobe Acrobat Reader. If you do not have Adobe Acrobat Reader, get a free copy by clicking on the link below.

Adobe Reader

When you have Acrobat Reader, click on the link below to download the New Patient form. Then print the form, fill it out, and bring it with you on your first visit.

Patient Registration (PDF)

We also have links to two consent forms. Either form can be printed if needed:

Consent for Endodontic (Root Canal) Therapy (Web Page)
Consent for Extraction (Web Page)

Payments & Insurance

We accept assignment on all dental insurance companies. Patients are responsible for their part of payment at the time service is rendered. All insurance companies are different and our quotes are estimates of what they will pay and are not guaranteed. We are a provider for United Concordia.

We also offer Care Credit to help with extensive treatment plans. Approval required. Vist Care Credit Now for details and pre-qualify for their services.

Feel free to contact  our office if you have any concerns or questions regarding your insurance company or payments.