Patient Info

First Visit

Your visit will include an examination, x-rays if needed, a report of the findings, recommendations, and education.



New Patient Forms

Click on the buttons below to download our New Patient Forms; Please bring the completed forms with you upon your first visit!

Registration Form HIPPA Form General Treatment Consent Form Medical History Form Dental History Form Insurance Information Form



Dental Insurance

Please remember that dental insurance is considered a method of reimbursing the patient for fees paid to the dentist and is not a substitute for payment. Some insurance companies pay a fixed allowance for certain procedures, and others pay a percentage of the charge. It is your responsibility to pay the deductible amount, including co-insurance, or any other balance not paid for by your insurance company. We try to simplify the preparation of your insurance claims, thereby holding down costs that are unrelated to the delivery of quality dental care to you and your family.

If you have insurance, we will, as a service to you, help you determine the coverage you have available and submit your claim. We ask that you assign your insurance benefits to us. Should you have financial problems which result in delaying payment of your bill, please contact us. We will make every effort to work out an acceptable payment plan to enable you to take care of your obligation. All delinquent accounts will be pursued to the fullest extent allowed by law. Persistent non-payment for services rendered will regrettably lead to termination of dentist patient relationship.



Prescriptions & Renewals

All prescriptions and authorizations for renewals should be requested during normal business hours. Please follow the doctor’s recommendation if he feels that it is in the best interest of your health to be seen and examined prior to prescribing the appropriate medications.



Emergencies & After Hours

Contact our afterhours number at 248-701-4092 to speak with a staff member or call 911 for an emergency.




Fees & Payments

We make every effort to keep down the cost of your dental care. Payment is therefore requested for services when a patient leaved the office. Visa and MasterCard are accepted. Again, we welcome you as a patient. Thank you for selecting us as your personal family dentist.





Cancellations

If you cannot keep an appointment, 48 hour notice is required to cancel and reschedule your appointment. This is a courtesy on your part and makes it possible to give an appointment to another patient.



Your Safety

Our commitment to your health involves more than quality dentistry. In today’s heightened awareness, we’ve established a sterilization program designed to ensure the safety of both patients and staff. You’ll probably notice our masks and gloves, but there’s more to it than that. We are proud to insist on the highest safety standards.



Referrals

Your Friends Are Our Friends, Thanks For Telling Them About Us!
Thank you again for coming to us. Any time you have a question or concern, do ask. We think candid communication – especially when it comes to your health – is evidence of quality care and mutual respect.