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Patient Forms and Instructions
To save time at your first visit, please print off the new patient forms, complete and bring to your appointment.
Surgical Medication Instructions
Insurances
Dental Insurance, either provided by your employer or a policy that you buy directly from a dental insurance company, is meant to help cover some of the costs associated with your dental care.
What Does Dental insurance Cover?
Although there are many ways that dental insurance can be provided, the typical employer dental insurance plan uses a network of participating dentists and has the following features (depending on where you live, and the number of people in your family that are insured):
• A maximum benefit of $1,000 to $1,350 per year
• Diagnostic and preventive care (dental plan pays 100%)
• Periodontal maintenance and cleanings (dental plan pays 80%)
• After 12 months, the dental plan may pay up to 50% of the cost of treating chronic gum disease
Our Insurance Policy
Our office participates in a number of dental insurance plans. Filing insurance claims is a courtesy that we extend our patients. We will help you by processing your insurance form and sending it in promptly. All co-pays will be collected at time of service.
If you have any questions about your dental plan, please feel free to call us at 216-221-5595.
Financial Policy
Financial Statement
We are committed to providing you with the best possible dental care. We also want to serve you in a manner which is comfortable and pleasant as possible. In order to achieve these goals, we need your assistance and your understanding of our payment policy.
We will gladly discuss your proposed treatment, give you as detailed an estimate as possible in writing, and answer any questions that we can about your insurance. If you have dental insurance we will assist you in receiving your maximum allowable benefits.
We cannot emphasis too strongly that the extent of your insurance benefits is defined in a contract between you, your employer and an insurance company. We are not a party to that contract. we had no input into any of the decision-making. as your dental care providers, our relationship is only with you, not your insurance company.
While the filing of insurance claims is a courtesy that we extend to our patients, all charges are your responsibility from the date that the services were rendered. We will help you by processing your insurance claim form and sending it in promptly. All co-pays will be collected at time of service. Payment can be made by cash, check or Visa, MasterCard or Discover Card.
Cancellation Statement
We understand that things come up that are out of your control. However, when an appointment is missed or cancelled with less than 24 hours notice, it is extremely difficult for us to fill that appointment time. If this occurs, you will be charged for the overhead cost of your missed appointment.
Guest Speaker
Dr.Thomas is available as a guest speaker. He brings a wealth of knowledge and experience, and a personable approach. He is both entertaining and informative.
Call 216-221-5595 to request a speaking engagement.