Now accepting new patients

All 4 documents below make up our new patient paperwork.

Contact and Insurance info sheet
We need to have this info to work with your insurance. We also need your cell phone and email so we can send you reminders. Phone calls are so yesterday! A text or email is less disruptive and more convenient.
Pt Information Sheet.doc
Microsoft Word Document 33.0 KB
Medical History Review
This form allows us to catch potential medical risks to dental treatment. Remember some dental treatment is moderately invasive. It can involve anesthetics containing epinephrine and other procedures that may cause mild to moderate bleeding. Also the Dr. may need to prescribe medication that could interact with medications you are currently taking.
Medical History.doc
Microsoft Word Document 30.5 KB
Consent to receive dental treatment
This document is a general consent that all patients sign. It is a consent to receive basic dental treatment. For example, radiographs (x-rays), photographs, anesthetic, and basic examinations. If we had to have a consent for each of these things there would be too many for each visit. Please ready thoroughly and feel free to ask any questions when you meet with the Dr.
Consent to Proceed.doc
Microsoft Word Document 26.5 KB
Financial Policy and Agreement to Pay for dental services
This one says you will pay your bills for the treatment rendered. We strive to make sure our patients understand the cost of treatment before proceeding. Please ask if you have any questions.
Fed. Truth in Lending.doc
Microsoft Word Document 28.0 KB

If you don't feel comfortable filling out the forms completely let us know.  If you have questions about the forms, or need help filling them out, bring them with you to your first visit.  Or just come by before and we will help you.  We will need all the information if you want us to bill your insurance, otherwise you are welcome to pay for the treatment in full and submit the claims to your insurance yourself.   Also without all the info we will not be able to offer either of our financing plans.  

 

Thanks Dr. Strong