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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 our office to serve your dental health care needs!

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) If you are unable to keep this or any future scheduled appointment, please let us know at least 24 hours in advance so we may offer your time to another patient. We make every effort to be on time, and ask that you do the same. It works like dominoes: if a patient is late for an appointment, it means that others may be kept waiting. Or, it could mean that we might not be able to complete all of your scheduled treatment.

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 this initial appointment. We accept cash, checks and most 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.

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

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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