The New Patient Registration Form is in Adobe Acrobat (PDF) format. If you do not have Acrobat Reader, get a free copy by clicking on the link below. The Acknowledgement form does not require the reader and will open in a new browser window.
Please print the New Patient Registration Form, fill it out, and bring it with you for your appointment.
Payment is expected at time of service. If you have insurance, you will be expected to make an estimated payment for that portion not covered by your insurance plan. For that portion of costs not covered by insurance, we offer several payment options:
- Cash or Personal Check
- Credit Card – We accept MasterCard, Visa and Discover.
- Care Credit financing – Care Credit offers 3, 6 and 12 month interest free payment plans, and extended financing up to 48 months. Apply in our office or apply online.
Dental insurance is intended to cover some, but not all of the cost of your dental care. Most plans include coinsurance provisions, a deductible, and certain other expenses which must be paid by the patient at the time of services. Reimbursement amounts are not, and never have been, a guideline for quality care.
We can file most insurance claims for you. Please bring your insurance plan information with you on your first visit. We will work with you to ensure that you receive the maximum benefits to which you are entitled.
If you have any questions about your insurance plan or payment options, please call our staff at (254) 772-3922 or e-mail us at todayFD@mydentalmail.com.