First Visit-Emergency Care

What to Bring:

• List of Current Medication, if applicable
• Dental Insurance Card, if applicable
• Previous xrays and records or fax Authorization of Release of Information form to previous dental provider
• Please print and fill out following forms:
  • Welcome Adult Health History
  • Authorization to Release Health Information
    ** this form is to be sent to previous dental offices for records and x-rays. For this form, please add to the Please Forward/release my health information to:

• Authorization for Release of Information
• Consent for Treatment
• Consent for Use and Disclosure of Health Information
• Directions to the office
• Notice of Privacy Practices (read only)
• Smile Evaluation
• Acknowledgement of Receipt of Notice of Privacy Practices

What to Expect:

We will treat you with respect. To determine the cause of your emergency, a limited examination and appropriate x-rays of the suspected area will be done to diagnose the problem and assess extent of the damage to the tooth or gum. We will answer all your questions and discuss options of treatment. Relieving your immediate discomfort is our goal, with your permission. We will help you understand your insurance coverage. Payment is expected at the time of service, in full or estimate of insurance co-pay.