Patient Forms
ESPAÑOL:
Puede acceder a los siguientes formularios para ayudarnos con su atención. Por favor, imprima y complete el Formulario de Registro del Paciente, Formulario de Historial Médico, Reconocimiento y Consentimiento Informado al Paciente y Acuerdo de Oficina y Política Financiera antes de su primera cita.
Financial
Insurance Policy
We are committed to helping patients maximize their insurance benefits. We are in network with Delta Dental, Wellmark Blue Cross Blue Shield, and Blue Dental. We can also file most insurance claims for out-of-network providers. As a courtesy, we will electronically file your insurance claims and work directly with your insurance company to receive applicable benefits. For your convenience, we accept cash, check, and credit card payments. Please call our office with any questions about your insurance or billing.
Payment Policy
A 3% discount is allowed when treatments are paid in full by cash or check in advance or the day of the appointment.
We also accept major credit cards such as: Visa, MasterCard, Discover, American Express.
FAQ
Are you taking new patients?
Yes, we are taking new patients of all ages.
What type of insurance do you accept?
We are in network with Delta Dental, Wellmark Blue Cross Blue Shield, and Blue Dental
What do I do if I have a dental emergency?
If you are a patient of record, please call our office and we will do our best to get you in as soon as possible.
If you are a new patient, please call our office to schedule an appointment for a full exam. We will evaluate your condition and determine the appropriate treatment.
What should I bring to my first apointment as a new patient?
Before your appointment, please ask your previous dental office to email your panoramic and bitewing X-rays, if available, to office@southsidesc.com.
Please bring: your dental insurance card (if applicable), a current list of all prescription and over-the-counter medications you are taking, and your SSN, as it may be needed to process your insurance claims.
You will also need to complete a few new patient forms. To save time at your appointment, you may download and complete them from our website, stop by our office to pick up a copy, or arrive a few minutes early to fill them out beforehand.
Do I have to pay upfront?
If you have dental insurance, we will file your insurance claims on your behalf. Once your claim has been processed, you will receive a statement if there is any remaining balance due.
If you do not have dental insurance, payment is due at the time of service. We accept cash, checks, and major credit cards. Patients who pay with cash or check on the day of service or day of treatment receive a 3% discount.