Please remember to bring the referral slip your doctor gave you to your appointment. Our office will make every effort to see patients who are experiencing an endodontic emergency; however, our appointed patients will have first priority. If you have an appointment that you cannot make, please inform our office as soon as possible. If you plan to use our payment plan, the approval process must be completed by you prior to your appointment. Please arrive 15 minutes prior to your scheduled appointment to fill out the appropriate paperwork. You may also download these forms and bring them completed to your appointment.

Save time in the office! Please feel free to print, complete, and bring the two forms below with you to your appointment.

We participate with most traditional dental insurance plans. We do not participate in any HMO or PPO insurance plans. We will estimate your co-payment, which is due at the time of service, from the insurance information you provide us. Please have your insurance information available when you schedule your appointment.

As a patient, you are responsible for all fees incurred at our office, and your out-of-pocket costs may differ from the co-pay we estimate at the time of service. We will submit claims for services rendered to your insurance carrier; however, any unpaid insurance balances are your responsibility and are due when your receive our billing statement. If you do not utilize our payment plan, your estimated co-payment is due at the time of service.

Fees are collected at the time of service in our office. We accept payments by cash, check, VISA, or MasterCard. We do have a payment plan which is administered by CareCredit. The plan requires a short pre-approval process which you must complete prior to obtaining service at our office. Due to Federal Law, we can no longer process your application at our office. Click on the link below to set up your billing option.

Patient Information and Health History

We offer a 10% discount for in-full, cash payment of your entire fee at the time of service. This discount is for actual payment in dollar bills, not payment by check. This discount is not applied to co-pays or offered if we take assignment of your insurance claim. Our office reserves the right to not apply or offer this discount at any time or for any reason.

Informed Consent and Receipt of HIPAA Policies

HIPAA Privacy Statement

Directions to Our Office/Blank Referral Form

After Your Root Canal Instructions