Patient Information

New Patient Forms:

New Patient form

COVID-19 Consent Form

HiPAA release form

HiPAA release form

COVID-19 Consent Form

New Patient form

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Financial Policy

For all procedures, your patient portion is due in full at the time of service. For your convenience, payments may be made with cash, check, Visa, MasterCard, or Discover.

Outside Financing

We have partnered with Care Credit to offer flexible financing options to help you get the care you need. Learn more at

Self Pay

Dental Insurance

We are a Preferred Provider (PPO) for many dental insurance companies. As a courtesy to you, we will bill your primary insurance company and track claims whether we are in or out of network. Please keep us informed of any changes to your insurance plans. If you need assistance, or have questions about your insurance policies or claims, our staff is knowledgeable and always available to help you.

We are currently not accepting HMO/DMO and Medicaid plans.

No Dental Insurance?

You can obtain the same quality of dental care with us even without dental insurance. We offer our patients discounted rates for treatment without any membership requirements. Additionally, specials are offered to first time patients without insurance:
– Emergency and problem focused exams with X-rays: $75
– Comprehensive exams with x-rays: $100
– Comprehensive exam, cleaning, and fluoride treatment for children under 12 years of age: $165

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Reservation Policy

Our doctors and hygienists want to be available for your needs and the needs of all of our patients. When a patient doesn’t show for an appointment, another patient loses an opportunity to be seen. We understand that unplanned issues arise and you may need to cancel or change an appointment. We respectfully ask for 48 business hours notice to avoid a late cancellation fee.

Appointment Cancellation Policy