New Patients

If you are a new patient, we will need to learn about your medical history and current problems. You may download the forms by clicking on the links below. The forms are in pdf format, so complete the forms, print them off, and bring them to your first visit.

To get the full form to print, you will need to print the version that was downloaded to your computer, not the browser version.

Who Are Good Candidates for a Smile Card Cost-Saving Membership?

  • Individuals and families that use an FSA or HSA plan to manage their medical expenses, not covered by dental insurance.
  • Younger individuals, married or single, who are not currently covered by dental insurance.
  • Senior citizens on a fixed income that are not covered by dental insurance.
  • Anyone that wants the maximum benefits of a dental plan as well as manageable costs.

Terms and Conditions

  • This is not an insurance product.
  • Monthly payment plan must be established prior to treatment.
  • Plan is canceled if the bank returns a monthly payment and no refunds will be given.
  • Fees for other treatment must be paid in full at time of service.
  • Any treatment not paid for at the time of service will be billed at the usual, customary, and reasonable rate.