New Patients
Forms
New patients can conveniently fill out the following forms prior to visiting Portrait Dental. Please download, fill out, print, and bring them with you to your next appointment. Complete each form to the best of your ability.
Please be sure to carefully review our office policies. Any required signatures will be completed upon arrival.
Also, print the following Privacy Consent Form and read thoroughly prior to signing. Signed consent forms must be presented upon arrival to your appointment.
Policies
Appointments & Cancellations
When you make an appointment, we are reserving time dedicated for your particular needs. We ask that if you need to change an appointment, please give us at least 2 business days’ notice. This courtesy will allow us to free up time for another individual that may need it.
Repeated cancellations or missed appointments will result in loss of future appointment privileges.
We appreciate your trust in us. In return, we value your time. When your appointment is made, we make special efforts to prepare your treatment room in advance with the necessary equipment based on the procedure required. In exceptional cases where we may have to provide emergency services to another individual, you can expect us to be prompt and to keep you informed. We will do our best to stay on time and would expect the same with your attendance at appointments.
Payment & Insurance
At Portrait Dental, as a courtesy to our patients, we will offer direct billing (as long as your policy permits). We will file your claim with your insurance company after services are rendered. Your “patient portion” and payment for services not covered by the plan, are expected to be paid in full at the end of the procedure.
Treatment plans decided between you and the dentist are based on your dental needs, it cannot be assumed that the insurance company will pay for all recommended treatment charges. Insurance companies also set their own fee allowances for dental treatment. It is important to understand that while some pay fixed amounts, other pay only a percentage; therefore, neither guarantees you full payment for services. It is the patient’s responsibility to pay any deductibles, co-insurance, or any portion not covered by your insurance.
Due to the Privacy Act we cannot be held responsible to know the details (maximums, frequencies) of your insurance coverage. We will however, gladly interpret policy booklets that you provide and handle any written pre-determinations.
Non-insured patients are expected to make payment in full on the day the service is rendered.
Free Whitening with New Patient Exam and Cleaning!
Come for your picture perfect smile!