Patient Registration Form
Dental & Medical History Form
Office Financial Policies Form
Dental Materials Fact Form
Cancellation policies: Last minute cancellations are disruptive and deny other patients the benefit of receiving the care they need in a timely manner. We appreciate every effort you can make to give us as much notice as possible but at least two business days notice if you need to change an appointment. Our policy applies a $150 charge in the event such appointment is not kept, cancelled or rescheduled with less than two full business days notice. Patients who repeatedly and exceedingly fail to show, cancel or reschedule without proper notice may be dismissed from the practice.
Payment Policies: Payments and co-payments are due in full at the time of dental services. We accept cash, Amex, Visa, Mastercard.
As a courtesy to you, should you have dental insurance coverage, we will file your claim with your insurance company as well but you are ultimately responsible for the full payment towards the dental services received. If you do not provide your current dental insurance coverage at least 2 full business days ahead of your visit, the fee for the entire visit will need to be collected at the time of service.