For your convenience, we have supplied a Health History Form in pdf format. Before your visit, please click on the links below, print, complete the form at home, and bring
it with you to your first visit! We look forward to greeting you!
New Patient Forms - Adult
New Patient Forms - Child
Your Dental Insurance
If you have dental insurance, we will help you to maximize the benefits to
which you are entitled. We will also be to estimate your,coverage
and to process your claims as a courtesy
to you. Many variables exist from
carrier to carrier, however (deductibles, annual maximums, allowable fee
limitations, non-covered procedures, Usual and Customary Fee Schedules,
etc.), and we cannot guarantee private payment portion estimates as
anything other than what they are - estimates
. Dental insurance plans are
intended to support your investment in your dental health rather than to
cover all procedures completely, and the degree of your coverage will always depend upon the particular contract that you and/or your
employer have chosen. Ultimately you are responsible for charges incurred. If your insurance carrier has not paid its portion within thirty (30) days
from the start of treatment, we may contact you to request that you call
your insurance company. Often, your call will speed the consulting process
and the approval of compensation. If your insurance company has not
paid its estimated portion within 90 days from the start of treatment, we
will let you know, you will become responsible for satisfying all
additional requests from your insurance company, and subsequent
reimbursement from your carrier will be made directly to you.
We'll be glad to clarify any aspect of your treatment or financial obligations/arrangement.
Don't hesitate to ask us for more information!
As always, in your best interest,
Dr. James Rhode and Staff