We are asking you to complete new patient questionnaire enabling our clinical and administrative staff to prepare for your first visit and to make your check-in for your appointment quicker and easier.

**Please note that there are several documents needing to be filled out.**

Patient Questionnaire

Emergencies
If you experience a dental emergency, be sure to call our office as soon as possible. If you need immediate attention after hours, call our emergency phone number at (805) 398-0878 and our on-call staff member will help you. If you are unable to reach your dentist during an emergency, dial 911.

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Dental Insurance
If you have dental insurance we will gladly submit your claim on your behalf. However, we cannot guarantee any estimated coverage, as the insurance policy is an agreement between you and your insurance carrier.

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Health Savings Account as an Alternative to Dental Insurance
A health savings account usually supplements one’s current medical insurance coverage, although with some HSAs you don’t have to have medical insurance coverage. These types of health savings accounts pay for medical and dental expenses that your health insurance coverage typically does not pay for.

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No Show / Cancellation Policy

When we make your appointment, we are reserving a room for your particular needs. We ask that if you must change an appointment, please give us at least 48 business hour notice. This courtesy makes it possible to give your reserved room to another patient who would like it.

There is a charge for not showing up for scheduled appointments. Repeated cancellations or missed appointments will result in a NO-SHOW/LATE CANCELLATION FEE of $50.

We feel that our patient’s time is valuable. When your appointment is made, a room is reserved, your records are prepared, and special instruments are readied for your visit. Except for in the case of an emergency for another patient, you can expect us to be prompt and respectful of your time as well.