Patient Forms

Our staff will help you to schedule appointments, complete necessary paperwork, and answer any billing questions that you may have.

General Dental Forms

Patient Registration

Medical History Exam

Consent for Dental Services and Notification of HIPPA privacy act

OFFICE FINANCIAL POLICIES and ASSIGNMENT AUTHORIZATION

Orthodontic Forms

Patient Registration

Consent for Dental Services and Notification of HIPPA privacy act

Patient Appointments
We, at South Meadows Dental & Orthodontics make every effort to be on time for our patients, and we ask the same courtesy from your family. If you cannot keep an appointment, please notify us immediately, giving a minimum of 48 hours notice to avoid any missed appointment fees. We realize that unexpected illnesses and emergencies may occur, but we ask for your assistance in this regard.

Our office strives to schedule appointments at your convenience and when time is available. 

Insurance & Patient Co-payments
If you have insurance we will help you determine the coverage you have available. Should you be diagnosed with treatment services, we will be able to provide you with a detailed plan which will give you an estimate of how much your insurance company may pay for each procedure, as well as the portion you will be expected to pay at the time of service.

Professional care is provided to you, our patient family, and not to an insurance company. The insurance company is responsible only to the patient as a benefit from the employer or individual plan purchase, and the patient is responsible to the doctor. We will assist you in every way we can in the filing of your dental claim and handling of insurance questions from our office on your behalf.

Financial Policy
In an effort to reduce the cost to you, the patient, while maintaining the highest level of professional care, we have established the financial policy as follows:

We gladly accept Cash, Check, Visa, Discover, American Express, or MasterCard payments.

• 
Orthodontic Treatment can be financed in-house
• Payment plans are available through www.CareCredit.com.

Request of Previous Records

Should you have current x-rays and/or chart notes that you would like our doctors to have available to them, our business team will be happy to assist you in obtaining them. We will ask for the name of your previous dentist and a phone number. In addition, any records can be forwarded to info@southmeadowsdental.com

If you have questions about the consultation services we provide, please email us today or call at (775) 852-8181.