Dental Patient Registration Forms
Each form must be printed out seprately
Each form must be printed out seprately
Click Here for the Dental No Show - Red Flag Policy
Welcome to our dental practice!
Thank you for choosing our office to provide you with dental care. Please
complete the enclosed information and return to our office.
• You will be contacted to schedule your initial appointment once your information has been entered into our system, your records have been received (if applicable), and your insurance coverage has been verified.
• No insurance? You will have the opportunity to meet with someone in our billing office to see what you may be eligible for. You will need your birth certificate and picture ID or passport, social security card, and verification of income.
• If you have seen a dentist within the last 5 years, please fill out the enclosed Records Release and send to your previous dentist. Due to the high demand, we have also had to put a policy into place not to reschedule a brand new patient who “no-shows” to two initial appointments. A no-show is defined as: not coming to a scheduled appointment, arriving more than 15 minutes late for an appointment, or cancelling with less than 24 hours notice.
We look forward to meeting you.
Sincerely,
Sofia Archuleta,
Administrative Coordinator, Dental Program
• You will be contacted to schedule your initial appointment once your information has been entered into our system, your records have been received (if applicable), and your insurance coverage has been verified.
• No insurance? You will have the opportunity to meet with someone in our billing office to see what you may be eligible for. You will need your birth certificate and picture ID or passport, social security card, and verification of income.
• If you have seen a dentist within the last 5 years, please fill out the enclosed Records Release and send to your previous dentist. Due to the high demand, we have also had to put a policy into place not to reschedule a brand new patient who “no-shows” to two initial appointments. A no-show is defined as: not coming to a scheduled appointment, arriving more than 15 minutes late for an appointment, or cancelling with less than 24 hours notice.
We look forward to meeting you.
Sincerely,
Sofia Archuleta,
Administrative Coordinator, Dental Program
