Forms

Below are forms to print out and complete before your first visit.

Schedule Your Appointment!

Forms

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Improve Your Smile! Contact Us Today!

Schedule Your Appointment!

Payment Options

Cash, Check, Credit Card:  Visa, Master Card, Discover and American Express, CareCredit

Discounts

5% cash discount for non-insured patients, when charges are paid in full by cash or check.

5% non-insured senior discount for patients 65 years and older.

Insurance Network Participation

Delta Dental / MODA- Premier

Cigna Dental PPO

Aetna Dental

We work with many insurance companies. Please be advised that plans may vary even amongst the same insurance provider. We are happy to assist you with your insurance and financial questions.

Ameritas

Assurant

DenteMax Network

Guardian

LifeMap

LifeWise

Met Life

Regence Blue Cross Blue Shield

United Concordia

United Healthcare

Please take a moment to print out and complete all of the new patient forms listed below. We ask that you please complete all necessary forms prior to arriving at our office to help ensure your appointment starts and concludes on time. Delaying the start of your appointment to complete patient forms may require scheduling a second appointment to finish your initial cleaning and exam.

Patient Registration
Medical History
Notice of Privacy Practices
Acknowledgement of Receipt of Notice of Privacy
Financial Agreement