Patient Forms


Appointment Request Form
Whether you're a new or returning patient, let us know your day and time preferences along with the reason for your visit and we'll quickly get back to you with convenient appointment options.
Health History Form
Easily complete our Health History Form from your computer, tablet, or smartphone. If you are unable to complete the form electronically, you may download a hardcopy and bring it with you to your first appointment.
Dental Insurance Form
If you're a new patient using insurance or a returning patient whose insurance information has recently changed, please keep us updated with this form.
Patient Information Update Form
Periodically, we will ask you about changes to your contact information, health, and insurance.
COVID-19 Safety Screening Form
Keeping our patients safe during the pandemic is our top priority. We will ask you to complete this form prior to your appointment.
Privacy Policy
Please review our privacy practices before completing the Health History Form.
Dental Materials Fact Sheet
Please review the information about dental materials before completing the Health History Form.

Our Appointment Policy

Thank you for choosing our practice for your dental health needs. We are dedicated to providing you with quality care.

We respect our patient's time and attempt to schedule appointments that are convenient for you. While we always try to stay on schedule, complications and emergencies may arise with other patients that could delay us. If we are significantly delayed, we'll make every effort to notify you beforehand so you may choose to come later or reschedule. If you are going to be late, please let us know. If you are significantly delayed, your scheduled treatment may be modified or you may be asked to reschedule your appointment.

Because we reserve time exclusively for each patient, we ask that, if possible, you not change your appointment. If you can't keep your scheduled appointment, we require a minimum of 48 hours notification so we can make your reserved time available for other patients. To notify us of any change, please call our office during business hours or leave us a message.

In order to maintain the most efficient schedule for our patients, our Appointment Policy is as follows:

Your First Appointment

We offer a free cosmetic consultation to all new patients interested in cosmetic dentistry. During the consultation we will discuss your options for creating the smile you've always wanted.

For a general dental patients first visit, all areas of your mouth will be thoroughly examined. This will include a detailed examination of the teeth, oral cancer screening, supporting structure alignment, bite, and more. A complete set of x-rays will be taken and models of your teeth will be made if necessary. All the information that we obtain will be carefully evaluated so we may accurately assess your dental needs.

Preventive Oral Hygiene Appointment

After your examination, you will be ready for the preventive oral hygiene session. At this time, you will have access to the latest theories and techniques for controlling dental disease. Specific approaches will be recommended for your individual needs. Your teeth will also be cleaned by our skilled dental hygienist. We consider this session to be one of the most valuable services we offer to our patients.

Dental Evaluation and Plan for Treatment

After your preventive appointment, we will explain your dental evaluation and plan for treatment, including immediate needs and long-term objectives. Our recommendations will be based on the goal of your receiving maximum life for your natural teeth.

Financial Arrangements

Payment is expected at the time services are performed. We accept cash, checks, Visa and Master Card.

Dental Insurance

As a service to our patients, we will prepare all of the necessary insurance forms. However, we remind you that your policy is an agreement between you or your employer and your insurance company, not between your insurance company and our office.

We can make no guarantee of any estimated coverage, but we will do our best to see that you receive your maximum benefits. Please keep in mind that you are responsible for your total obligation should your insurance benefits result in less coverage than anticipated. If you would like to know what your expected coverage will be, we will submit a pretreatment estimate. Your insurer will generally send a detailed response within four to six weeks.

Cosmetic Dentistry and Insurance

Cosmetic procedures are generally not covered by most dental insurance policies. However, partial benefits are often available if the teeth are broken or have previous dental fillings, bonding, or crowns. Also, most insurance companies will pay approximately 80% of the cost for metal fillings on back teeth. If a more expensive tooth-colored filling material is used, the insurance company usually still pays their percentage based on the cost of the less expensive metal filling.