Information for Our Patients
If you are a new patient to our Houston dental office, the forms below will need to be filled out when you arrive for your first appointment in our office. Printing them, Filling them out and bringing them with you will allow us to attend to your dental needs more quickly than completing them upon your arrival.
New Patient Welcome Forms 2019
This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.
Sometimes a tooth will act up suddenly and you find yourself in immediate need of a dentist. We allow time in our schedule to accommodate dental emergencies, and you will receive an appointment on the same day you call.
For your convenience, we accept cash, personal checks and major credit cards including, VISA, MasterCard, AMERICAN EXPRESS & DISCOVER. Payment is expected at the time services are rendered. When more extensive dental care is necessary, financial arrangements can be made at our office.
As a service to our patients, our practice accepts most dental insurance programs, including non-managed care and PPO out-of-network. We are not part of any managed care network. Our accounting staff will prepare all the necessary forms for your dental benefits. However, we remind you that your specific policy is an agreement between you and your insurance company. Please keep in mind that you are responsible for your total obligation should your insurance benefits result in less coverage than anticipated. Our staff will gladly submit a pre-treatment estimate to your insurance company so that you will know what your benefits will be.
The fees charged for services rendered to those who are insured are the usual and customary fees charged to all our patients for similar services. Your policy may base its allowances on a fixed fee schedule, which may or may not coincide with our usual fees. You should be aware that different insurance companies vary greatly in the types of coverage available. Also, some companies take care of claims promptly while others delay payment for several months.
We are pleased to offer our patients CareCredit, North America’s leader in patient payment plans. CareCredit lets you begin your treatment immediately – then pay for it over time with low monthly payments that fit easily into your monthly budget.
Like a credit card, but better
CareCredit works like a credit card, but is exclusive for healthcare services. With no up-front costs, no pre-payment penalties, and no annual fees, CareCredit lets you pay over time and frees up cash and credit cards for the other things you want or need. CareCredit offers low monthly payment plans for healthcare procedures not commonly covered by insurance, including dental treatment. Plus, you can use your card again and again to pay for additional treatment for yourself or family members in any CareCredit practice.
Low minimum monthly payments
No-interest financing if paid within 12 months (Additional plans may be available)
No up-front costs, pre-payment penalties or annual fees
Learn more by visiting CareCredit.com or contacting our office. It only takes a few minutes to apply for CareCredit and you may receive an online decision in seconds! For more information or to apply now, just click on the link below.