Online Patient Registration

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SUBMIT PATIENT PAPERWORK ONLINE
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Paper Patient Application

pdfClick here to download our Patient Application

Health History

pdfClick here to download our Health History Form

HIPPA Form

pdfClick here to download our HIPPA Form

Policies

pdf Click here to download our Policies Form

Policies

We strongly believe in the quality and excellence of our work and professional efforts, and we therefore ask you to read this section carefully. In order to provide you with the best care possible, we ask for your commitment in regards to the following policies.

Commitment to Appointment Policy

An appointment in our schedule is a bond of trust that we will be here to serve you and you will be present for treatment. Our office policy is firm in this regard, and we will not tolerate frequent cancellations or constant short-notice changes. In fact, if you don’t provide a minimum of 24-48 hours notice prior to your appointment time, you may be charged a minimum of $75 missed appointment fee and up to the entire appointment fee to compensate our providers for their time.

Commitment to Financial Arrangement Policy

We believe we have the responsibility to use the best professional care, skill, and judgment in planning and delivering your dental treatment. Your payment reimburses us for our services, materials, time and investment.  We believe that we have the responsibility to deliver excellence and professionalism in a caring environment where our patients feel as if they are part of our family. We foster relationships with our patients built on mutual trust. We appreciate you fulfilling your part of the arrangement by attending your scheduled appointments, completing your prescribed treatment, and providing payment in full where applicable. By signing the policies form below, you are indicating that after all fees are properly explained to you that you agree to fulfill your financial commitment to our office promptly and completely.