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New Patient Form PDF Download

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New Patients

We will schedule appointments as soon as time permits and at your convenience. Preschool children should be seen in the morning because they tend to be well rested and therefore more cooperative. This allows our staff to work more leisurely with the child for their comfort. School aged children that require extensive work should also be scheduled in the morning time for the same reason. While we understand that missing school is a concern, it can be kept to a minimum when regular dental care is sustained.

Appointment times are reserved exclusively for each patient, therefore we ask that you please notify our office at least two business days in advance of your scheduled appointment time if you are unable to keep your appointment. Other patients in need of our care could be scheduled if we have sufficient time to notify them. We do understand and realize that emergencies do occur, but we ask for your assistance in this regard. If you do not call to cancel and fail to show as scheduled, you may be charged a broken appointment fee.



Payment Options

Payment for professional services is due at the time dental treatment is provided. We accept cash, personal checks, and most major credit cards including Visa, MasterCard and Discover, as well as debit cards which bear the Visa or MasterCard logo.



Insurance Claims
We file dental insurance claims as a courtesy to our patients. We do not have a contract with every insurance company, therefore, we are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim. We will assist you in estimating your portion of the cost of treatment, but we cannot guarantee what your insurance will or will not do with each claim. 


What insurance plans do you take?
We currently accept Arizona and Nevada Medicaid, and most PPO's (* We also accept most other insurances, If you have any questions please call for details). If you have any questions or concerns about your particular insurance plan, do not hesitate to contact the office. As a courtesy to our patients we will be happy to file a claim on your behalf but ultimately the responsibility for payment of the claim belongs to the patients. Please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment status.



Insurance providers we work with may change at any time and without notice. If you have any questions regarding your insurance provider, please contact our office at (435) 635-7200  - Thank you.

You may have noticed that sometimes your dental insurer reimburses you or the dentist at a lower rate than the dentist's actual fee. Frequently, insurance companies state that the reimbursement was reduced because your dentist's fee has exceeded the usual, customary, or reasonable fee ("UCR") used by the company. The data used to establish fees may be dated and are set by the insurance company so they can make a profit, too.
Insurance companies set their own schedules, and each company uses a different set of fees. These allowable fees may vary widely because each company collects fee information from claims it processes. The insurance company then uses this data to establish their fee schedule.

Additional Financial Information
Dental insurance is meant to be an aid in receiving dental care. On average, most dental insurance plans pay between 50%-80% of the average total fee. Some plans pay more, some pay less. The percentage paid may be determined by how much you or your employer has paid for coverage or the type of contract your employer has set up with the insurance company.

If we have received all of your insurance information on the day of the appointment, we will be happy to file your claim for you. You should be familiar with your insurance benefits, as we will collect from you the estimated amount insurance is not expected to pay. By law your insurance company is required to pay each claim within 30 days of receipt. We file claims in a manner such that your insurance company will receive claims within days of the treatment. You are responsible for any balance on your account after 30 days, whether insurance has paid or not. If you have not paid your balance within 60 days, a finance charge of 1.5% or $5, whichever is greater, may be added to your account each month until paid.

What kind of payment plans do you have?
We expect all patient portions and deductibles to be paid when service is provided. We implemented and enforce this policy to keep costs down for each of our patients. Prior to treatment, our staff will provide an estimate of the treatment costs or co-pay. Usually the co-pay is a close estimate but in some cases an additional amount will be due. In the event extensive treatment plans are required, financial arrangements can be discussed. 


Do you offer any financing options?
As a service to our patients, we are pleased to offer Care Credit. With Care Credit you can finance 100% of your dental care and there are no upfront costs, no annual fees, and no prepayment penalties. So, you can begin your treatment today and conveniently pay with low, monthly payments. We also offer Lending Club, call us today for more information!

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