Patient Resources

For your convenience, you can access our Patient Registration forms by clicking on the New Patient box.  You will need Acrobat Reader to access these forms. Click here for a free download.

To access additional forms, click on the link below:
Patient-Information-Form.pdf
Patient-Health-Info-Form-Epworth.pdf
Notice-of-Privacy-Practices.pdf
Acknowledgement-of-Receipt.pdf
Hipaa_Authorization_Form.pdf
Invisalign Patient Consent and Agreement.pdf
Zoom-Informed-Consent.pdf
Vizi-Lite.pdf
Endo-Consent-Form.pdf

Visit the links below to learn more about Zoom, Invisalign and ViziLite:
Zoom
Invisalign
ViziLite

Insurance/Financial

Payment is required at the time of services rendered.  We accept cash, personal checks and most major credit cards.  Our practice is not a participating provider of an organized insurance plan, however, as a courtesy, we will file all insurance claims for you.

The Chart ID can be found on your Billing Statement.