Patient Resources

Learn more about our office's policies and procedures by exploring the links below. We want to help our paitents feel confident in their decision to vist Southside Family Dentistry. If you have any questions, please call us at 712-722-2525.

Patient Forms

Financial

FAQ

Patient Forms

ENGLISH:

You may access the following forms to assist us with your care. Please print and fill out the Patient Registration Form, Medical History Form, Patient Acknowledgments & Consents, and Office Policies & Agreements online before your first appointment.

Patient Registration Form

Medical History Form

Patient Acknowledgements & Consents

Office Policies & Agreements

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 en línea antes de su primera cita.

Formulario de Registro del Paciente

Historia Medica

Reconocimiento y Consentimiento Informado al Paciente

Acuerdo de Oficina y Política Financiera

Financial

Insurance Policy

We help patients maximize their insurance benefits and are in network with Delta Dental and Blue Dental. We’ll also file most insurance claims as an out-of-network provider. As a courtesy, we will file claims electronically and accept assignment of benefits. Your co-payment or deductible is due at the time of service. Pay by cash, check, or credit card. Please call our office with any questions.

Payment Policy

A 5% 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

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