accessibility ACCESSIBILITY
Call: (336)584-8132

New Patient Info

If you are a new patient to our office, the attached files contain our new patient forms that will need to be filled out when you arrive at our office.  Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all.

Welcome                                                                                                                                                                                                        

Patient Registration

Medical History

Assignment and Release

Acknowledgement Of Receipt of Notice of Privacy Practices

Notice of Privacy Practices

Authorization for Email Appointment Reminders


 


We are happy to announce illumisure. This is a plan where people can make small monthly payments which is less than price of coffee or cigarette pack .Through this plan you are able to afford basic services, and get discounted prices on other dental procedures as well. PLUS there is a bonus—once you have been in the plan for six months, starting at your second cleaning and every other cleaning thereafter you get bleach strips.

We hope this program can help students, family on a budget, retired people, and anybody who does not have dental  insurance.

                                                                    

 

 

 

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This web site uses files in Adobe Acrobat Portable Document Format  (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.


Payment Options

For your convenience, we accept cash, personal checks, money orders and major credit cards. Payment is expected at the time services are performed. We offer extended financing through Carecredit and Citi Health Card that can be customized to fit any budget.

Insurance

As a service to our patients, our practice accepts most dental insurance programs, including non-managed care, indemnity (traditional) and PPO out-of-network.  We are part of several insurance networks.  Our accounting staff will prepare all the necessary forms for your dental benefits. However, we remind you that your specific policy is an agreement between you and your insurance company. Please keep in mind that you are responsible for your total obligation should your insurance benefits result in less coverage than anticipated. Our staff will gladly submit a pre-treatment estimate to your insurance company so that you will know what your benefits will be.

The fees charged for services rendered to those who are insured are the usual and customary fees charged to all our patients for similar services. Your policy may base its allowances on a fixed fee schedule, which may or may not coincide with our usual fees. You should be aware that different insurance companies vary greatly in the types of coverage available. Also, some companies take care of claims promptly while others delay payment for several months.