* Please allow 30-45 seconds for each form to download to your computer.
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New Patient Registration Form (Required before your first visit) |
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Health History Information Form (Required before your first visit) |
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Dental History Information Form (Required before your first visit) |
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Transfer of Dental Records Form |
When you arrive for your first visit, please be prepared to complete all insurance and health information forms that will allow us to begin your dental treatment.
We will ask you to fill out our New Patient Forms that will help us get acquainted with you.
If you are unable to make the appointment you have scheduled with us, please notify us at least 24 hours in advance. We would be glad to reschedule the appointment at a more convenient time, if necessary. In the meantime, we look forward to meeting you and serving your needs.
Please remember to bring any Insurance cards that might apply to you or your family when you come. We can then include this information with your records.
The minute you walk in the door, you will be welcomed by our friendly staff. You will then be accompanied to the treatment room where Dr. Chiang will complete your Comprehensive Examination which will include:
Review of your medical and dental history
Clarify your concerns, wants and expectations and/or problems
A series of diagnostic X-rays will be taken to provide a detailed radiographic view of your teeth and bone condition.
Oral Cancer Screening- the insides of your cheek, your gums, the sides, top and bottom of your tongue, the roof and back of your mouth will be examined for normal and abnormal sores or lesions.
Complete Periodontal Exam- the gums and bone that surround your teeth will be evaluated for signs of hidden gum disease.
Comprehensive dental evaluation is recorded in your tooth chart showing your existing and needed dental work.
Tour your mouth with a “miniature video camera” at high magnification.
A “Treatment Plan” which is a written explanation of the complete findings about your dental health. We encourage you to ask questions because your input into your treatment plan is very important.
"Cleaning” of your teeth may be done depending on the results from this exam. Dental cleanings are done by our qualified staff members.
After your examination Dr. Chiang will review all finds; discuss your treatment recommendations and sequence; give you a customized written report and answer all questions to your satisfaction and understanding at your first visit.
Our Financial Coordinator will meet privately with you to cover your treatment and financial options and our fees
Your treatment plan will include a estimated breakdown of all applicable fees, and we will inform you of all estimated costs before treatment is administered. Charges are payable at the time of treatment.
Please ask a member of our staff, and we will review our payment options to accommodate your financial needs. Please also ask a member of our staff about financial arrangements through CareCredit.
We will submit all insurance claims for you. If we are not providers within a certain insurance plan, we are still happy to submit your claim as an out-of-network doctor. We will fully attempt to help you receive full insurance benefits; however, you are personally responsible for your account, and we encourage you to contact us if your policy has not paid within 30 days.
We are contracted providers of Delta Premier and Cigna. In addition, we also accept a variety of PPO plans.
Please keep in mind that your benefits are not determined by our office. Insurance policies are contracts between the insurance company and you, or your employer. We make our financial arrangements for dental services with you, not with
your insurance company.
Please understand that we file dental insurance as a courtesy to our patients. Although we are happy to assist you, please know that it is your responsibility to understand your policy. We will assist you in estimating your portion of the cost of
treatment, but we at no time guarantee what your insurance will or will not pay with
each claim.
There are no insurance companies that pay for 100% of all procedures. Dental insurance is intended to be an aid in paying for dental care. Most dental plans pay between 50% - 80% of the total fee. This percentage is determined by how much you or your employer has paid for the coverage, or the type of contract set up with the insurance company. At
times, you may be notified by your insurance company that its reimbursement rates are
lower than our actual fees.
Often, insurance companies will state that your reimbursement has been lowered because a dentist's fees exceed the "usual and customary rates" (UCR). This is misleading. There are hundred of insurance companies that offer dental insurance, and each company sets its own schedule for what they consider allowable. These allowable rates vary greatly.