Although you are more than welcome to fill out these forms when you arrive at our office, we have put them here for you print off and fill out at home at your leisure.
Personal Data Card
**A deductible is a dollar amount that must be reached before an insurance plan provides coverage. The patient is responsible for payment until the deductible is met. Check with your insurance provider to determine your deductible.
*Co-pays are the patient’s share of treatment cost and are due at the time of service. They are a set amount and specific to each insurance plan. Check with your insurance provider to determine your co-pay, if any.