You may print / fill
out the new patient forms and bring it on your first visit if you would
like to keep filling out paper-work to a minimum on your initial visit.
New Patient Forms
Please provide ID and
insurance card on your first visit.
Because we value
patient’s time, we reserve our staff and Doctor for your appointment.
But if you must reschedule your appointment, we ask your courtesy of 24
hour notice prior to your appointment. This will help us to have
another patient take that appointment time.
There will be $50.00
charge for inadequate notice of cancellation or missed appointment.
Our
office accepts traditinoal and most PPO dental insurance plans (please
call our office
for more information 703-825-7840). Please provide your
dental insurance information over the phone when scheduling an
appointment. This will result in more accurate and complete
verification of your benefits prior to your visit. It will
help payment and decision-making more convenient for you.
New
Patient Forms
- Forms of payment- cash, checks, credit cards
(VISA/MASTER),
Care Credit (no interest / low interest financing
plan),
Visit www.CareCredit.com
for more information or call our
office
- Payment is due on the day that services are
rendered.
Self-pay patients, or patients not utilizing insurance coverage or
discount plan, with payment over $1500.00 and making full payment on
the day of service, will receive a 5% discount (excluding Care Credit).
There will be $50.00
charge to patient’s account for a returned check and the account must
be paid in full within 10 days to avoid collection activity.
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