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Patient Forms

Patient Information

Health Questionnaire

Request for Release of Records

HIPPA Notice of Privacy

HIPPA Consent


Adobe Acrobat required. Forms can be printed or completed electronically.

E-mail electronically completed forms to or print completed form and bring with you to your appointment.

Payment & Financing Options

We respect your time, your finances, and above all - the lifetime quality of your smile and good dental health. We believe that you should be just as comfortable with the cost of your services as you are with their quality, and that is why we accept the following payment options:

• Cash

• Check

• Debit Card

• Visa, Mastercard, American Express and Discover

We also offer payment options though CareCredit.

Apply at or 800-677-0718.

If you lack dental insurance, we offer Smile Advantage.

An insurance alternative and a healthier smile are within reach! Join today and enjoy free exams, x-rays, and cleanings, plus 15% off all other dental services.

click here to learn more.

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