Patient Forms
You can fill out your new patient paperwork via our secure portal prior to your appointment. As a HIPAA compliant practice, we always take extreme precaution that all patient information is securely transmitted and added to our systems.
Make a Payment
Make a quick and easy payment online. All you need is a payment method handy.(Click "Make a Payment", enter full name/date of birth, and follow the steps)
Patient Portal Login
Log-in to your patient portal access your patient information, treatment plan, appointments, etc. If you need login information, it was emailed to you with subject line "Patient Portal Invitation." If you can not access it, then please email us and we can help.
No Insurance? No problem.
Our office offers discount membership plan for patients who do not have insurance. Free cleanings and free exams are some of the key features of this plan.
Patient Referral Form
( Must be filled out by Referring Doctor )
We welcome referrals from doctors as we provide a comprehensive dental services in one office. To submit a patient referral, please submit our patient referral form
Sedation consent forms
Our office offers anxiety-free sedation for patients who fear dental treatments. We require Sedation consent forms to be submitted prior to your sedation appointment.
Consent for unaccompanied minors
We recognize that parents may drop a minor patient off or the minor patient may drive themselves to their dental appointment. In order for us to be compliant with State laws and Dental Board regulations, we do require a signed consent form that permits our providers to treat an unaccompanied minor (under 18).
Responsibility of financial payment
Any or all treatment whereby a patient (above 18) can not pay for treatment and requires someone else to pay for the patient's treatment, then the patient can assign another person the responsibility party for all financial obligations for treatment
Specific Dental Power of Attorney
Depending on patient situation, we may require the patient to appoint an agent to make any and all dental care decisions for the patient. Any agent appointee can be revoked in writing to our office via email or fax.
Sleep Apnea Clearance Form
If you are eligible for sleep apnea and you would like to get it reimbursed from medical insurance, then you must get this sleep apnea clearance form signed by your medical doctor or primary care provider.
Medical Clearance Form
If our doctors require that you receive a medical clearance form to do dental work at our office, then you must get your primary care provider to fill out this form and submit it to our office.
Sedation Clearance Form
If you are interested in sedation dentistry, then our doctors will require that your medical doctor sign off on this form to do sedation dentistry at our office. Call our office for more information and they can set-up the correct process to start sedation dentistry.