Please download and fill-out our Patient Registration Forms. After you have completed the form, please make sure to bring them on your first visit to our office. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.
- Registration, Consent, Acknowledgments & Releases
- Patient Health History form
- Patient Dental Insurance form
- WDG Notice of Privacy Practices
- Dental Materials Fact Sheet
We deliver the finest care at the most reasonable cost to our patients, therefore payment is due at the time of service. For your convenience, we accept cash, Visa, MasterCard, American Express and Discover. Because we pride ourselves on seeing our patients at their scheduled time, we ask our patients to let us know if they cannot make their scheduled appointment 48 hours in advance. Missed and day of appointment cancellations and changes may be subject to a fee. We ask your cooperation as this allows us to fill the appointment slot with other patients needing emergency treatment.
Our practice is pleased to present flexible payment plans through Lending Club Patient Solutions. Enjoy a selection of flexible plans with low fixed rates and monthly payments, no upfront payment, and no prepayment penalty.
It’s easy to calculate your potential monthly payments. Simply complete a short application which displays fixed rates and monthly payments available for Extended Plans, all without impacting your credit score.
For more information, simply ask a team member or visit lendingclub.com/patients.
We also accept CareCredit®. Approved patients receive a credit card that allows them to purchase healthcare services not covered by insurance.
If you have questions regarding your account, please contact us
As a courtesy to our patients with dental insurance, we are happy to submit your primary dental insurance claim forms using the insurance information you provide. Most insurance companies will respond within four to six weeks. Please familiarize yourself with your insurance benefits. We will collect payment for services based on the estimated amount insurance is not expected to pay. You will be responsible for payment of all fees whether insurance has paid or not within 60 days of the service. We will be happy to send a refund to you of the insurance amount paid to us. Any remaining balance after your insurance has paid is your responsibility. Your prompt remittance is appreciated.