Thank you for choosing Family Dental Care!
What to bring to your first visit:
You may download the new patient forms below or arrive for your appointment 15 minutes early to complete the forms in our office.
New Patient Registration Forms
If you do not have an insurance card, please bring the insurance carrier name, claims address, phone number, group number and policy ID number for your policy to your appointment.
- Name, date of birth and social security numbers for the policy subscriber, parent or guardian and patient.
- Drivers license or state ID for the patient or responsible party.
- Name and phone number of your doctor if you are currently under the care of a physician.
- List of current prescription medications.
- Any current x-rays from your previous dentist. Your prior dental office may email x-rays to our office at: firstname.lastname@example.org.
- Payment for services and/or co-pays.
are excited to participate with the majority of all PPO
insurance networks. This means our insured patients enjoy saving 30-50% on
service fees!(excluding managed care plans)
we do our best to assist patients with their dental benefits, it is
important for patients to know and understand their coverage. Including;
annual maximums, deductibles, covered services and plan limits.
Patients are responsible for payment for services not covered under the
network plan. All treatment plans are based on computerized estimates in
coordination with your insurance carrier. All estimates are subject to
change due to the nature of insurance rules and/or clauses. Some plans may have waiting periods and insurance companies may arbitrarily exclude some services from coverage. We make recommendations based on what is best for your oral health as opposed to what insurance companies will or will not cover.