Forms and Policies

New Patient Forms

As a new patient, you will be asked to complete the New Patient Forms that includes our patient registration form, medical records release form and HIPAA privacy policy.

We kindly request forms to be downloaded and completed before the appointment time.

Insurance Policy

We accept all PPO insurance. We are currently NOT accepting any HMO or medicaid, medicare policy.

Listed below are the current insurances we accept:

  • Aetna
  • Anthem
  • Ameriplan
  • Assurant
  • BlueCross BlueShield
  • Cigna
  • Carrington Dental
  • Comp Benefit
  • Delta Dental
  • Dental Benefit Provider
  • Florida Blue
  • Florida Combined
  • Guardian
  • Humana
  • Metlife
  • SIDS
  • United Health Care
  • United Concordia
  • Unicare

As a convenience to our patients with dental insurance, our office will submit the charges to your insurance carrier at no extra cost. However we do ask that you provide us with complete insurance information.

Please understand that your insurance is a contract between you and the insurance company. No insurance company covers all dental costs. Some companies pay fixed allowances for certain procedures and others pay a percentage of the charge. You are responsible for payment of the balance.

It usually takes three to six weeks for benefits to be paid. If after 60 days the insurance company has not paid, we ask the patient to pay the balance on their account. We will continue to seek settlement from your insurance company for a reasonable period of time. It may be necessary for the patient to contact their insurance company to expedite payment.

Financial Policy

We have made and will continue to make every effort to keep the cost of your dental care reasonable. Our policy is to request payment at the time of your dental treatment. We appriciate payment at the time of service rendered to avoid collection fees.

We do our best to adjust to our patient’s requirements and finances. Our treatment coordinator will work with you to arrange a treatment plan that fits your schedule and budget.

We are happy to discuss every procedure and fee before we begin. We also will help you arrange for payment, as several options are available including a dental fee plan, Care Credit, Lending Club and interest free financing. In addition we have a pre-payment discount and we accept credit cards. Please talk to one of our receptionists if you have any questions.

Patient Referrals

Our practice is growing because of referrals from patients like you, and we thank you for your thoughtfulness.

We regard it as a vote of confidence when our patients recommend our office to their friends, co-workers or family members.

We welcome and accept new patients and appreciate these referrals.