For your convenience, we have supplied a Health History Form in pdf format.  Before your visit, please click on the links below, print, complete the form at home, and bring it with you to your first visit!  We look forward to greeting you!

New Patient Forms - Adult
New Patient Forms - Child

If you have dental insurance, we will help you to maximize the benefits to which you are entitled. We will also be to estimate your,coverage and to process your claims as a courtesy to you. Many variables exist from carrier to carrier, however (deductibles, annual maximums, allowable fee limitations, non-covered procedures, Usual and Customary Fee Schedules, etc.), and we cannot guarantee private payment portion estimates as anything other than what they are - estimates. Dental insurance plans are intended to support your investment in your dental health rather than to cover all procedures completely, and the degree of your coverage will always depend upon the particular contract that you and/or your employer have chosen. Ultimately you are responsible for charges incurred. If your insurance carrier has not paid its portion within thirty (30) days from the start of treatment, we may contact you to request that you call your insurance company. Often, your call will speed the consulting process and the approval of compensation. If your insurance company has not paid its estimated portion within 90 days from the start of treatment, we will let you know, you will become responsible for satisfying all additional requests from your insurance company, and subsequent reimbursement from your carrier will be made directly to you. We'll be glad to clarify any aspect of your treatment or financial obligations/arrangement.

Don't hesitate to ask us for more information!

As always, in your best interest,
Dr. James Rhode and Staff