We offer our New Patient paper work online for your convenience. You can print the forms, fill them out and bring them with you to your appointment.

 

Forms

In order for us to verify your insurance prior to your visit we will need a few pieces of information unique to your insurance plan.

    If you are the insurance holder with card present, we need:

  • Member I.D. number*
  • Employer or Insurance Plan name
  • Insurance Provider service phone number
  • P.O. box for claim submission

     *In the case of no Dental card present, your social security number may be used in place of the member I.D. number.

     If you are not the Insurance primary member, we will need:

  • Primary member’s full name and date of birth
  • Primary member’s I.D. number or social security number
  • Employer or Plan name
  • Insurance Provider service phone number
  • P.O. box for claim submission
  •