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New Patient Form

Welcome to our practice! We would love to hear from you. To contact us about scheduling an appointment or to submit a patient testimonial, please call our office for an appointment or complete the digital form below. We will be in touch with you. Have a great day.

New Patient Forms

Welcome to our practice! We are very excited to meet you. For your convenience, we have provided links to our New Patient Forms to make your check-in time as quick and seamless as possible. You will see links to our New Patient Registration Form and our HIPAA Privacy Form below. You are more than welcome to print these forms and have them filled out prior to your first visit. This will save you time during the check-in process and will help us to better serve you.
New Patient Registration Form
HIPAA Notice Practices
HIPAA Acknowledgement

If you have any questions about these New Patient Forms, please do not hesitate to call our office. If you do not have time to fill out these forms prior to your first visit, you may do so when you arrive for your appointment. Please arrive at least 10-15 minutes prior to your scheduled visit to complete this information.

General Office Information and Policy

Appointments:

We are dedicated to staying on schedule and seeing all of our patients on time for their appointments. We do ask that our patients be on time for scheduled appointments, planning extra time for travel or filling out forms. We recommend arriving 5-10 minutes early to ease the check in process. Please be aware that dental emergencies do arise throughout the day which may delay or extend your appointment. We are committed to treating all true dental emergencies and will advise you immediately as to the status of your appointment.

Cancellations:

We reserve time especially for you, for your appointment. If you need to change your appointment, we ask for a minimum notice of 24 hours. Should you cancel after the 24 hours, please be advised that you will be charged a broken appointment fee in the amounts of $100 per missed cleaning and $50 per half-hour of restorative appointments. Consecutive missed appointments can result in being dismissed as a patient.

Emergencies:

If you have an urgent problem, please call our office early so we may see you as soon as possible. If you have an emergency after hours, please call our office for information on how to contact the doctor on call.

Weekend and After Hours:

Patients of record with true dental emergencies after regular business hours, which cannot wait until the following day, should call our office for information on how to contact the doctor on call. A pager number will be left on the office answering machine. Call this number and leave a message, someone will return your call promptly.

New Patient Registration Form
HIPPA Notice Practices
HIPPA Acknowledgement