PATIENT REGISTRATION FORMS
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We know that you lead a busy life and don't want to spend more time than necessary filling out forms once you reach our office. For your convenience we have provided the Patient Health History forms that you can print, fill out and bring with you for your dental appointment. Please ensure that all 7 forms are completely filled out when returning them to our office.
Patient Information
Medical Health History
Medications
Office Policies and Financial Agreement
Notice of Privacy Practices
Acknowledgement of Receipt of Notice of Privacy Practices
Consent for Use and Disclosure of Health Information
Periodically we will ask you to update your medical history. Please print and fill out this Medical History Update form when it is requested by our office and bring it with you on your next visit.
FINANCIAL ARRANGEMENTS
Our fees are based on the materials we use and our experience in performing your needed treatment. To ensure that you have access to the finest dental treatment available, we have developed the following financial options:
We offer a Dental Credit Card for easy monthly payments.
We accept Major credit cards such as Visa, MasterCard, Discover and American Express.
We are pleased to offer CareCredit to our patients. CareCredit is a convenient, no initial payment, low monthly payment plan for dental treatments of $0 to $25,000. Offering CareCredit allows us to make the smile you've always wanted affordable. Click here to view and print or fax the credit application.
We also offer financing through Wells Fargo, Citi Health Card and Healthcare.
If you would like to review our financial arrangement options, or have questions regarding your dental insurance plan in advance of treatment, please call our office at 337-981-9811 or toll free at 800-433-5138.
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