We are delighted to welcome you to our practice and are pleased that you chose us to serve your dental needs. We are serious about providing you superior dental care and proud of our dedication to our patients. Our goal is to help you feel and look your very best through excellent dental care.

We appreciate the trust you have placed in us. One of our primary concerns will be to make you feel comfortable in our office. We are interested in developing a long term, mutually satisfying relationship, which will enable and encourage you to maintain your dental health. If you have any questions, please do not hesitate to discuss your concerns with us.

Treatment:
   In order to prevent dental disease, the active disease must be evaluated and eliminated. Therefore, we must have a complete picture of your present oral health conditions, as well as insight into your dental and medical history. We will make a thorough evaluation of existing and potential problems, taking the necessary X-Rays and examining the oral tissue for decay and gum/bone disease.

Insurance:
   We will be happy to work with any insurance company that allows you to chose your own dentist. Your insurance policy is an agreement between you, your employer, and the insurance company. We will submit all claims for procedures performed in this office. In some cases we may even be able to estimate how much your insurance will contribute, financially, toward your dental treatment. Please remember that this is just an estimate, your insurance company makes all final decisions on payment. You are responsible for any and all fees regardless of your insurance decisions.

Appointments:
   You will find that we respect our patient's time and make every effort to remain on schedule. We try to complete treatment in as few visits as possible. Because we are considerate of our patient's time, we have found that they are likewise considerate of our time. A missed appointment is a loss for everyone. We require a 24 hour notice if an appointment must be changed so we may offer it to another patient A fee of $30 to $50 will be incurred for a missed appointment without proper notice.

I have read and understand the above and give consent to begin treatment for and agree to be responsible for: