New Patient Forms

Below you can find our new patient forms. You are welcome to print and fill them out. 


We ask that you realize that we do not work for an insurance company. Rather we work 100% for our patients. We feel that insurance can be a great benefit for many patients and want you to know we will do everything in our power to ensure you get every benefit allotted in your insurance contract. However, the treatment we recommend and the fees we charge will always be based on your individual needs and not based on your insurance coverage.

Dental Insurance and Our Office

Nearly all dental insurance plans have annual maximums, deductibles and copayments.

We are considered out-of-network with many major insurance plans. This means the insurance may or may not pay a portion of fee for dental work. For whatever the insurance does not cover, and any deductibles, is wholly the patient’s responsibility.

Network Assignment of Benefits

As we are considered out-of-network with many insurance plans, we do accept assignment of benefits with the following insurance companies.

  • Aetna
  • Assurant
  • Cigna
  • Delta Dental
  • Guardian
  • Maverest
  • Metlife
  • SunLife Financial
  • United Concordia
  • United Healthcare

Insurance Frequently Ask Questions

What are annual insurance maximums?

If your insurance is subject to an annual maximum, that means that the insurance company will pay only up to a predetermined amount in a plan year. 

Most plan cycles are calendar year but some are fiscal year (July-June).

These maximums can range from $500 to greater than $4000.


What are assignment of benefits?

All insurance companies require payments for treatment to be assigned to either the subscriber (patient) of the dental office. 

In most cases the assignment of benefits will be toward our office, if your plan permits the assignment to us. 

What is a deductible and co-insurance?

If your insurance plan is subject to an annual deductible that means that the insurance company will defer payment responsibility to you until that deductible is met.

As we are out-of-network with all major insurance companies, whatever the insurance does not pay for becomes your co-insurance and your responsibility.


How do I find out if your office takes my insurance?

Although we will do our best to make sure you utilize the most of your dental insurance, we cannot guarantee that we are familiar with your particular plan. To get the information you need most insurance companies have a dedicated member phone number for you to call.



Payment Options

This office accepts all different types of payment options and will work with you to find the best one that suits you. We accept payment through all major credit card companies, including VISA, MASTERCARD, AMERICAN EXPRESS and DISCOVER.

We also accept payment via cash, checks and through third-party payment plans with CareCredit.

What is Care Credit?

Think of CareCredit as your own health, wellness, and beauty credit card. 

Whether it is oral surgery, getting a crown, or a general check up, you should not have to worry about how to get the treatment you need and deserve.

That is why we are pleased to accept CareCredit.

CareCredit lets you say “YES” to recommended surgical and non-surgical dental treatment and pay for these services in convenient monthly payments that fit your financial situation.

Why should I consider CareCredit?

CareCredit is a healthcare credit card that helps you pay for treatments and procedures for you or your family with easy monthly payments and in some cases. “no-interest” plans can be utilizied.

With special financing options, you can use your CareCredit card again and again for your dental needs, as well as at over 200,000 other healthcare providers, including, optometrists, veterinarians, ophthalmologists, and hearing specialists.

We welcome you to ask our staff about this health care credit card.

How do I apply?

It is free and easy to apply and you will receive a decision immediately.

If you are approved, you can schedule your appointment to get the treatment you need and deserve even before you receive the card in the mail.

With more than 21 million accounts opened since CareCredit began nearly 30 years ago, they are the trusted source for healthcare credit cards.

Learn more by visiting or contacting our office.

Ready to apply? Apply online for your CareCredit healthcare credit card today. You’ll be smiling brighter in no time!

*Subject to credit approval. Minimum monthly payments required. Visit for details.