Please download, complete, and electronically sign (using Adobe Acrobat Reader) the forms you were requested to fill out prior to coming to our office.
If you are able to do so, please print your completed forms and bring them with you to your appointment.
If you do not have a printer, please save your completed forms on your device, bring the device with you to your appointment, and you will be able to print them at our office.
This form outlines responsibility for payment for services and the role of dental insurance in the transaction.
Credit Card Authorization
Completion of this form allows for remote credit card payment processing.
Please keep these COVID19 safety points in mind for your next appointment.