Patient Information
PATIENT RESPONSIBILITYPERTINENCEREFERRALREGISTRATION FORMSREQUESTING SOCIAL SECURITY NUMBERCANCELLATION POLICYTARDINESSPAYMENT POLICYINDEPENDENT FINANCINGPREPAYMENT REQUIREMENT FOR DENTAL LAB WORKDENTAL INSURANCEINSURANCE PAYS SUBSCRIBEREMERGENCY APPOINTMENTINITIAL APPOINTMENT (NON-EMERGENCY)TREATMENT PLANAPPOINTMENT ORDERAPPOINTMENT CONFIRMATIONSCHEDULE CHANGESAPPOINTMENTS FOR FAMILIESREFUSAL OF TREATMENTRECORD TRANSFER REQUESTQUESTIONSDISCLAIMERHIPAA NOTICE OF PRIVACY PRACTICESINITIAL APPOINTMENT (NON-EMERGENCY)
Prior to an initial appointment, we recommend that a copy of your records be transferred from any dentist visited in the last five (5) years. A form is available for this purpose.If x-rays are transferred from another dentist, the necessity of further x-rays will be assessed. Number, type, age, and clarity affect the usefulness of x-rays.
We request that for the initial appointment for a minor, a parent/legal guardian accompany the minor, so that the dentist may discuss the treatment determined by the comprehensive evaluation.
The initial appointment for a minor includes a comprehensive evaluation, bitewing x-rays, prophylaxis (cleaning), and fluoride treatment.
A fluoride treatment will be provided for all minors, unless the responsible party specifically requests in writing that it not.
The initial appointment for an adult consists of a comprehensive evaluation and a full mouth series of x-rays or a comprehensive evaluation and four bitewing x-rays with a panoramic x-ray.
For an explanation of the benefits of x-rays and/or the different kinds of dental x-rays, a pamphlet or video viewing is available upon request.
A "cleaning" will not be performed at the initial appointment for an adult. There are many different types of "cleanings", which require different amounts of time and treatment. The type each adult requires will be determined by the periodontal (gums) health, which will not be examined until the comprehensive evaluation.
