Forms & Downloads
- New Patient Form (PDF)
- Financial Policy (PDF)
Your dental plan is a form of compensation provided by your employer. It is our pleasure to file insurance claims on your behalf. All co-pays, deductibles and non-covered services will be collected at the time of service. Our insurance coordinators work with all insurance companies. It is important to recognize that your insurance company may change benefits, co-pays and deductibles throughout the year. We do our best to provide you with accurate coverage estimates based on the information legally made available to us. Many insurance companies will not give out fees until after the treatment is completed. As a courtesy, we ask that you keep us informed of any change to your insurance benefits. It is important that all information about you and your insurance benefits are current. - Medical History Review (PDF)
Fill out only if you are an established patient every 6 months - Payment Options Form(PDF)
Our treatments are highly individualized as well as our financial arrangements with our patients. For your convenience, we offer a variety of payment options. Our financial coordinator will help find options that are well-suited for your individual needs. - Privacy Practices (PDF)
- Patient Referral Form (PDF)
For doctors: refer patients to Children's Dental Center