Magnolia Family Dental Care | New Patient Forms in Ridgeland

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. 
• The last form is for your records and does not have to be returned to us....it simply states our HIPPA/Pricvacy Practices.

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."