Finances & Forms

Financial Policies

All financial policies will be explained in detail before treatment is started and we will provide assistance in claiming from insurance companies

Financial Policy / Payment Options: We offer different forms of payment to make our services more affordable for patients, and we will address any concerns regarding payment before treatment is started. We accept cash, debit, Visa, and Mastercard. Patients are responsible for payment of services rendered, irrespective of payment by a third party. Payments for services are due on the day of treatment, unless other arrangements have been made with the financial coordinator.

Insurance: We will submit claims to your insurance carrier on your behalf if you meet the necessary requirements. While we are happy to be of assistance, it is the patient’s responsibility to ensure that insurance coverage is active on the day of treatment and to be aware of the exact coverage amounts and percentages.

Forms

Please print and fill out the forms below prior to your first visit. Simply click on the links below to download them.

New Patient Form

For new patients before their first visit.

Medical History Form

For new patients before their first visit.

Medical History Update Form

To be completed once per year by returning patients.