New Patients Patients

New Patient Forms

The following forms should be completed prior to the first visit.
Please have the completed forms ready for the New Patient Coordinator at your first appointment:

Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.

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New Patient Questionnaire

The questionnaire includes contact and insurance information as well as your medical and dental history. You may fill out this form online and submit it via secure email, or print it off, fill it out, and bring it with you to your first appointment.

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Payment Information

Orthodontic treatment is an excellent investment in the overall dental, medical and psychological well being of children and adults. Financial considerations should not be an obstacle to obtaining this important health service. You will appreciate that we are sensitive to the fact that different people have different needs in fulfilling their financial obligations. We provide the following options.

For some insurance companies, we can set up a separate account for the anticipated insurance benefits. The benefits can be subtracted from the total treatment fee to make your monthly payments lower. Some insurance companies prefer to reimburse the subscriber; in those cases, we will still bill your insurance for you, but you wild receive the reimbursement.

We offer in-house financing with an initial down payment and monthly payments. This option is interest free. For your convenience, a payment book is provided.

We offer automatic monthly withdrawal from your checking or savings account so that you don't have to remember to mail a payment. We can also put your monthly payment on a credit card. There is no charge for this convenience.

Orthodontics is one health related expense that is a fixed amount per year. It can be easily planned, when determining how much to contribute per year. We will be happy to work with you regarding your flex account.

For those who choose not to finance their treatment, we offer a 5% paperwork discount if you pay in full with cash or check.

What to Expect at Your First Visit

When you arrive at our office, you will be greeted by our appointment coordinator. Please give her your new patient questionnaire. She will ask you to fill out a "get acquainted" form. You will receive an office tour and will become familiar with the tooth brushing, patient sign-in, and "on deck" areas. We will walk you through the treatment area and you will meet Dr. Weeden and the other team members. After getting acquainted, we will spend a few moments reviewing your history and learning about your orthodontic concerns. Then we will take a Panorex X-ray if one is not provided by your dentist. Dr. Weeden will complete a clinical examination. She will address your concerns and offer you solutions. To save an additional visit to our office, if you are ready for treatment, we can usually take the diagnostic records necessary for the doctor to complete your evaluation. There will be a charge for diagnostic records if you wish to have them taken. We have reserved an hour for your first visit and if you choose to have the diagnostics records taken, please plan for an additional half hour.