Forms
Please use the links below if you’d like to print a form. For your child’s first visit, you should print and complete the “Consent for HIPAA,” “Office Policies,” and “Patient Information” forms.
The First Visit
During your child’s first visit, we plan to do an examination, clean their teeth, take xrays (if indicated) and apply fluoride. If any treatment needs are found, we will work with you to formulate a treatment plan for that care. If no treatment needs are found, we celebrate first and then make a plan for your next examination, cleaning and fluoride treatment.
For your child’s first visit, a parent or legal guardian must attend the appointment. Please bring your child’s dental insurance card, your child’s birth certificate and your photo identification so that we may properly register you and plan for your care. Additionally, if any custody changes have occurred since the child was born, we will also need a copy of the custody documentation to determine which adults have the legal responsibility to make healthcare decisions. We request this information because dental treatment is irreversible and we need to be certain we are getting permission from the person who has the responsibility to make these decisions. We are thorough in all we do and hope that you appreciate our attention to the details.
Insurance
We have trained specialists to prepare and file your insurance claims for you. We do our best to estimate the benefits payable from your insurance companies and will process your benefits once the insurance company considers the submitted claims. We participate with Ameritas Insurance and will file insurance claims to all insurance companies on your behalf.
Payment
As much as we would love to never have to ask for payment to cover the services we provide, dental insurance rarely covers the costs of any treatment plan in full. We do our best to estimate your financial obligation and collect payment for the portion of care that we don’t believe will be covered by your insurance company. If we happen to miss the mark with our estimate and collect too much, it is our promise that we will get it refunded to you right away. Likewise, if we didn’t collect enough to cover your portion before treatment took place, we will ask for additional payment on the day of service or send a statement so that you can complete your obligation to us.
We accept cash, check and credit card payments. We also provide numerous Care Credit plans for your convenience. Please ask for more information if you are interested in using Care Credit. There is a six month, interest free plan available through Care Credit.
Because we offer general anesthesia services, some treatment plans can be quite extensive and expensive. In office general anesthesia does save you thousands of dollars compared to the use of hospital facilities, but the financial obligation is still higher than your typical dental appointment since everything is done at one time. Additional equipment, staff, education, supplies, medications and insurance are required to provide this service. We must receive payment for these services in advance so that we can avoid having to use additional resources to try to obtain the payment after treatment is provided. This helps keep the costs lower for everyone. This is a vital service we want to continue to provide to as many patients as possible but we cannot continue offering it when we have to divert practice resources to the collections process. We work hard to be compassionate and understanding and we ask that you do the same. Help us avoid conflict by doing your part to cover your obligations with us.