and New Patient Forms
As of April 14, 2003, the Health Insurance Portability and Accountability Act (HIPAA) went into effect. Our office has gone to great lengths to ensure the confidentiality and privacy of every patient. We are compliant with the electronic transmission of dental claims, including firewalls, software certification and requirements, and coding. A copy of our Notice of Privacy Practices is available to all patients and is posted in our office for your review. A written acknowledgment will be given to every patient to sign after reviewing our policies. You have the right to refuse to sign this form; however, we will not be able to transmit insurance claims on your behalf.
This form, Notice of Privacy Practices, presents the information that federal law requires us to give our patients regarding our privacy practices.
What to expect
Please assist us by providing the following information at the time of your consultation:
- Any current X-rays, if available
- A list of your current medical prescriptions
- Need for an antibiotic prior to dental treatment
If there are any questions regarding antibiotic pre-medication, please contact our office. This will also be covered when we review your medical history.
If you have dental insurance, bring the necessary information. This will save time and allow us to help you process any claims.
