Booking Forms
To ensure availability for a specific date, we recommend filling these 2-4 weeks ahead of time. Forms and deposit sent less than two week before the procedure may not get approved for the specific date.
Please start by filling out & Submitting the following 2 online forms:
Online HIPAA Complaint Medical Questionnaire
Finacial Agreement and Disclosure
Please note to book a date a $300.00 deposit payment is due 2 week in advance. Please see the Financial agreement PDF above for details.
Invoices will be sent by Email by Autobooks online and payable using a checking account. .
If you prefer pay by Credit Card there is an additional $2.8% fee and new invoice will be sent from Paypal.
Pre-anesthesia Instructions
Please print and save for reference. Review this form now and again the day before the procedure.
Pre-anesthesia Instructions and Eating / Drinking Guidelines
Financial Guidance
We are a fee for service practice and do no accept any insurances. Please be informed that we will not discuss billing with your insurance or fill up any insurance or claim forms.
However should you elect to you may contact your insurance to see if they may reimburse you for some of the fees.
Please use the Insurance Guidance PDF below to contact your insurance ahead of time if yiu care to do so
Pediatric Insurance Guidance Information
The form below may help you with reimbursement. The decision to fill it is your choice but should be filled by both your child’s pediatrician and dentist.