Patient Forms
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Before your first office visit, please fill out all 5 forms below and save to your computer.
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If you have dental insurance, please send us a copy of the front and back of your card. *If you were not issued a card, please provide us with this information in an email: - SS # & Date of Birth for the patient & policy holder - Insurance Company name & Group number - Insurance Company Address & Phone number - Insurance ID number - Employer of policy holder
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If we are not provided with your Dental Insurance information before your visit, you will pay our usual and customary fee for the services that day.
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If you have questions, please feel free to contact us. Thank you and we look forward to seeing you!
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Once completed, please email the forms to our office at
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* Adobe Acrobat Reader DC is a free and good program to help read pdf's and allow you to fill-out the forms.