New patient forms consist of 3 pages that must be filled out in its entirety and signed.
- These pages are Patient Information, Financial Policy/Acknowledgement of HIPPA, and Dental Health History forms .
These forms can be mailed, faxed, or e-mailed, prior to your appointment. You can also bring these forms with you to your appointment along with a photo ID and your insurance card.
**IT IS YOUR RESPONSIBILITY TO KNOW WHO YOUR INSURANCE IS WITH AND WHAT YOUR INSURANCE COVERS.
**WE WILL DO OUR BEST TO VERIFY ALL BENEFITS, BUT YOU ARE RESPOSIBLE FOR ANY AMOUNT NOT PAID BY YOUR INSURANCE COMPANY.
**PAYMENT IS DUE AT TIME OF SERVICES UNLESS OTHER ARRANGEMENTS HAVE BEEN AGREED UPON BY YOURSELF AND THE STAFF OF "MAGNOLIA FAMILY DENTAL CARE."