To download the forms and information you need, simply click the links
below. For added convenience, our forms can be downloaded and saved for
You can print and complete the Patient Information Packet (Patient Information, Dental Insurance, Financial Policy, and Privacy Practices Acknowledgement) in advance. This will allow us to process your information more rapidly
and potentially get you treated more quickly.
We are committed to providing you with the best possible care, and we are pleased to discuss our professional fees with you at any time. In order to assist you with the investment in your dental health, we have outlined our payment policy.
Option 1: Payment in full by cash or handwritten check on the day of the procedure = 5% discount. (Insurance will reimburse you according to your plan benefits.)
Selecting this option gives you the maximum savings on the cost of your treatment.
Option 2: Pay ½ balance on the day of the procedure then the remainder of the balance divided equally for the next three months, no interest.
Option 3: Payment in full on the day of the procedure by CareCredit, six or twelve months with no interest. If you choose this option, you must apply for CareCredit online at www.CareCredit.com or 800-365-8295 prior to your appointment.
If you have any questions, please ask our staff. We can be reached by phone at 478-742-4254.
Patient Information Packet
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