To save time, print these forms and fill them out ahead of time. These standard new patient forms help us get you started off on the right foot!
Please call us at 541-490-4993 to schedule an appointment.
Arrive at the office 5 min early, with the form, or 15 minutes early to fill it out at the office. Please arrive with your child's teeth brushed.
We accept several major dental insurances. If we do not receive your accurate insurance information, we are unable to bill your insurance. Please be familiar with your plan and be prepared for any amount that may not be covered, such as a co-pay. Please contact your insurance or contact us prior to your first appointment to ensure you have coverage with our office. Please keep us informed if any insurance changes occur. We do not bill any state insurances.
It is the patient’s responsibility to keep scheduled appointments. Our practice requires notification of cancellation at least 24 hours prior to the appointment or earlier if possible. Our practice will consider an appointment a No Show any time a patient has not given 24 hours advance notice of cancellation or has failed to arrive within 15 minutes of their appointment time. Patients who No Show for 2 appointments in a 1-year period will be dismissed from the practice. Patients may also be subject to a $65.00 missed appointment fee. The Cancellation and No Show fees are the sole responsibility of the patient and must be paid in full before the patient’s next appointment. We understand that Special unavoidable circumstances may cause you to cancel within 24 hours. Fees in this instance may be waived but only with management approval. Our practice firmly believes that good physician/patient relationship is based upon understanding and good communication.