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•	Medical History Adult
•	Medical History Minor
•	Notice of Privacy Practices
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Call 542-3305 to schedule an appointment.

FOR THOSE OF YOU NEW TO OUR PRACTICE, thank you for choosing and trusting our office to serve your dental needs. At this first appointment, we ask that you arrive 10 minutes prior to your scheduled time to complete some necessary paperwork and to show us a picture ID to satisfy requirements of federal Homeland Security regulations.

When you schedule an appointment, time is reserved in our office just for you, time when we can give you our complete attention. (At this first appointment, please arrive 10 minutes prior to your scheduled time to fill out some necessary paperwork.)

Our goal at your first visit is to record some of your dental and general health history, conduct a comprehensive examination and take some basic x-rays. Using this information and what you tell us about your needs and desires, Dr Jones can develop a treatment plan for your continuing dental health. If you want, or if she finds any urgently needed treatment, you can schedule an appointment to address it right away. We'll usually suggest a cleaning appointment with our hygienist and set you up on a recall schedule for regular cleanings and checkups.

For Your Benefit: There are a couple of areas in which your understanding and assistance will make all the difference.

1) When you schedule an appointment, time is reserved in our office just for you, time when we can give you our complete attention. We understand that, occasionally, an unexpected circumstance may arise making it necessary for you to cancel or change an appointment. This can leave a serious void in our schedule. Please provide us at least 24 hours advance notice so we can offer the time previously reserved for you to another patient in need.

A void in our schedule is a loss to three people: the patient who missed time reserved for them; a patient who could have used the doctor or hygienists' time; the doctor who was fully staffed and prepared for the appointment.

We will routinely file dental insurance claims to your carrier after each visit. Please bring your insurance identification card with you so we can store the information in our secure computer database.

2) To establish credit in our office, payment in full is requested at the time of service for your initial appointment. We accept cash, checks and bank cards. For subsequent appointments, we offer a courtesy for payment in full at the time of service so long as there is no existing balance, or 60 days for payment in full without finance charges.

Dental Emergencies:

For patients of record, we make every effort to address dental emergencies promptly. During office hours, call us at 542-3305. If you have a dental emergency outside of regular office hours, you can leave a message on our secure voice messaging system including your name, telephone contact number (very important!) and a brief description of your problem. We check messages periodically and someone will get back to you.

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