New Patient Information

New Patient Information

 

Dental Forms for New Patients of Todays Dental

 

If you are a new patient to our office, the attached files contains our new patient forms that will need to be filled out when you arrive at our office.  Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all.

 

Patient Forms  (click on each form separately to open and print at your convenience)

 

Forms for Beverly Office

 

TD Welcome Form 1

TD Welcome Form 2

Todays Dental – Dental Program (available only at Beverly location)

Todays Dental Photo Release – Beverly

 

Forms for Plainfield Office

 

TD Welcome Form 1

TD Welcome Form 2

TD_Photo_Release_Form – Plainfield

 

Payment Options

 

For your convenience, we accept cash, personal checks, money orders, and major credit cards. Payment is expected at the time services are performed. When more extensive dental care is necessary, financial arrangements can be made with our office.

 

Financing

 

Many patients put off treatments and procedures because they cannot afford to pay. Doctors offer CareCredit payment options as an alternative to consumer credit cards, cash or checks. CareCredit allows you to pay over time instead of a lump sum prior to treatment. Offering CareCredit removes the accounts receivable responsibilities from the doctor and allows them to focus on recommending and providing the best care to their patients.

 

Insurance

 

As a service to our patients, our practice accepts most dental insurance programs, including non-managed care, indemnity (traditional) and PPO out-of-network. We are not part of any managed care network. Our accounting staff will prepare all the necessary forms for your dental benefits. However, we remind you that your specific policy is an agreement between you and your insurance company. Please keep in mind that you are responsible for your total obligation should your insurance benefits result in less coverage than anticipated. Our staff will gladly submit a pre-treatment estimate to your insurance company so that you will know what your benefits will be.

The fees charged for services rendered to those who are insured are the usual and customary fees charged to all our patients for similar services. Your policy may base its allowances on a fixed fee schedule, which may or may not coincide with our usual fees. You should be aware that different insurance companies vary greatly in the types of coverage available. Also, some companies take care of claims promptly while others delay payment for several months.