Please fill out the appropriate form as requested , print out, and bring with you on your first visit, or you may e-mail to the completed form to email@example.com
Instructions for the forms:
Please fill out the form in Microsoft Word, when finished, go to file "Save As" and save your form as your name, then attached your completed form, and return to firstname.lastname@example.org
At the first visit to the orthodontist, Dr. McNeil will evaluate your dental problem and make treatment recommendations. Then diagnostic records can be made to finalize the treatment plan. Complete diagnostic records typically include a medical/dental history, clinical examination, digital study models of the teeth, photos of the patient's face and teeth, and X-rays unique to orthodontics. This information is used to develop a custom treatment plan for each patient. These records are also helpful in tracking the progress of treatment as the teeth move under orthodontic care.
After the doctor has evaluated your records, we discuss your treatment plan with you in detail.
The appointment when you get your braces usually takes from one to two hours. You will then see us at regular intervals of every three to six weeks for an adjustment, which takes approximately 10 to 15 minutes. Patients are seen by appointment only. We make every effort to be on time for our patients, and we ask that you extend the same courtesy to us. If you cannot keep an appointment, please notify us immediately. Cancel only if it is unavoidable. It is difficult to reschedule you since most appointments are made weeks in advance.
The cost of treatment depends on the type of treatment for the patient's problem. You will be able to discuss fees and payment options before treatment begins. We have payment plans to suit different budgets. We also accept assignment from most insurance plans, and file the necessary claims to the insurance company. We work hard to make orthodontics affordable.
In an effort to keep orthodontic fees down while maintaining the highest level of professional care, we have established this financial policy:
- If full payment is made at the onset of treatment, we will offer a fee discount.
- To fit your individual needs, financial arrangements can be made to extend your payments over a period of months.
- Family discounts are available.
- For your convenience, we accept payment by DISCOVER, VISA, MASTERCARD, and AMERICAN EXPRESS.
- In cases of serious past due accounts, treatment may be interrupted, although we will make every effort to accommodate patients with temporary difficulties.
If you have insurance, we will help you to determine the coverage you have available. We ask that you assign your insurance benefit to us. The balance will be arranged for you to pay (see above). Professional care is provided to you, our patient, and not to an insurance company. Thus, the insurance company is responsible to the patient and the patient is responsible to the doctor. We will be happy to help in filing your claim and handling insurance questions.