14631 Lee Highway Suite 211, Centreville, VA 20121 Tel: (703) 825-7840

New Patients

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

Payment and Financial Options

  • 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.