Being well-prepared for your appointment will ensure that the doctor has all of the needed information to provide the best possible care for you. It also will help relieve any unnecessary anxiety you may be feeling. New patients can expect to fill out a patient history form as well as our Notice of Privacy Practices form. The information on these forms is necessary to provide the best dental care for you.
Please print off the following forms and fill out for your first visit to North Liberty Dental.
New Patient HIPPA Form
Except for emergency visits, the initial visit is spent conducting a thorough examination which includes:
- A complete medical history to protect your health.
- Clinical exam of head and neck, including teeth and all soft tissues.
- Oral cancer screening.
- Create a baseline of existing restorations
- X-rays to detect decay and to determine the condition of the supporting bone.
- Addressing questions and/or concerns pertaining to your oral health
As a result of this careful examination, we can determine a practical treatment plan for you. This plan will tell you what treatment is needed, why it is needed, how much it will cost, and an estimate of how much insurance will cover (when applicable). If there is more than one case of treatment to be considered, each one will be discussed.
At North Liberty Dental, we make every attempt to make dentistry care affordable. We realize and recognize that our high-quality dentistry is not inexpensive, but we want to give every one of our patients an opportunity to say “yes to the best”, so we have set up several options to make comprehensive treatment more affordable for you!
- Cash, Check
- MasterCard, Visa, Discover Card and American Express
- Insurance Assignment (as a courtesy, we will file your insurance claims for you)
- Payment Plans
Please note that here at North Liberty Dental we collect payment for treatment the day of service. If you have dental insurance we will estimate your co-payment based on the information supplied by your insurance company. If there is a balance after insurance has paid their portion, we will bill you for the remainder, you are responsible for that amount, not your insurance company.