You may preregister with our office by filling out our secure online Patient Registration Form. After you have completed the form, please make sure to press the Complete and Send button at the bottom to automatically send us your information. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.
Please kindly indicate the appropriate form corresponding to the office for which your appointment is scheduled.
Note to Patient: Upon filling out your first name, last name, email and at least one phone number field (a valid home or cell phone) a button will appear in the upper right corner titled “Save and Exit” . This button allows you to save and exit your form to complete at a later date. The system will send a registration email to the email provided on the form, so that you may setup a login to go back and finalize your registration form online.
In addition to cash and personal checks, we also accept: Visa / Mastercard / Discover / CareCredit®
After completion of the root canal therapy, as a courtesy, we will file your insurance claim for you. The balance of the fee not covered by insurance is due at the time of service. While we attempt to calculate your portion from your insurance company as closely as possible, it is not always possible. Therefore you may receive an additional statement after insurance has paid their portion. We will do our best to determine your remaining insurance benefits, but knowing your yearly insurance limit is your responsibility. Please advise us of any insurance changes.
The fee is to be paid in full on the day of your appointment unless other arrangements are made with us. If you cannot meet this payment schedule, please visit with the front desk personnel to discuss your financial situation.