Patient Information

Scheduling

We encourage you to come our office for a no-obligation visit to meet the Dentists and staff to help you make a decision on who will provide your dental care.  If you are ready to schedule an appointment towards a beautiful, healthy smile please contact our office @ 717-263-8288 or complete the appointment request form. Our scheduling coordinator will contact you to confirm an appointment!



New Patient Forms

If you are a new patient to our office, the forms below will need to filled out when you arrive for your first appointment in our dental office. Printing them, filling them out and bringing them with you will allow us to attend to your dental needs more quickly than completing them on your arrival.  Thank you and please call our Chambersburg dental office @(717) 263-8288 if you have any questions or need any assistance.

Patient Registration Info.docx

medical hx.pdf

patient financial agreement.pdf

Notice of Privacy Policies (2).docx

HIPPA signature.docx

This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

 

Payment Options

For your convenience, we accept cash, personal checks, money orders and major credit cards including, VISA, MasterCard, & DISCOVER.  Payment is expected at the time services are performed. When more extensive dental care is necessary, financial arrangements can be made with our office.

Insurance

As a service to our patients in our practice, we provide a courtesy electronically submission of all insurance claims the day the service is provided. Our staff works extremely hard to maximize your dental benefits to gain maximal coverage for services provided. However, we remind you that your specific policy is an agreement between you and your insurance company. Please keep in mind that you are responsible for your total obligation should your insurance benefits result in less coverage than anticipated. Our staff will gladly submit a pre-treatment estimate to your insurance company so that you will know what your benefits will be.

The fees charged for services rendered to those who are insured are the usual and customary fees charged to all our patients for similar services. Your policy may base its allowances on a fixed fee schedule, which may or may not coincide with our usual fees. You should be aware that different insurance companies vary greatly in the types of coverage available. Also, some companies take care of claims promptly while others delay payment for several months.



Financing

Care Credit

We’re pleased to offer our patients CareCredit, North America’s leader in patient payment plans.  CareCredit lets you begin your treatment immediately – then pay for it over time with low monthly payments that fit easily into your monthly budget. 

Like a credit card, but better 

CareCredit works like a credit card, but is exclusive for healthcare services.  With no up-front costs, no pre-payment penalties, and no annual fees, CareCredit lets you pay over time and frees up cash and credit cards for the other things you want or need.  CareCredit offers low monthly payment plans for healthcare procedures not commonly covered by insurance, including dental treatment.  Plus, you can use your card again and again to pay for additional treatment for yourself or family members in any CareCredit practice.

• Low minimum monthly payments
• No-interest financing if paid within 12 months (Additional plans may be available)
• No up-front costs, pre-payment penalties or annual fees
  
  Learn more by visiting CareCredit.com or contacting our office. It only takes a few minutes to apply for CareCredit and you may receive an online decision in seconds! For more information or to apply now, just click on the link below.