Patient Forms & Insurance

New Patient Forms

We want you to know how much you mean to us before you ever step foot in our office. That’s why we always mail out a welcome packet to all of our new patients. This packet contains some important forms that you can fill out in the comfort of your own home. We are here to help you with anything you need, so don’t hesitate to call us at 704-752-0500 if you have questions.

Secure Online New Patient Registration Forms

Save time by filling out all your new patient forms online in a secure, HIPAA compliant portal. Click on the graphic below.

Paper Forms to Download, Print, Fill Out & Bring With You

• Patient Information Form
• Appreciated Patient Latter
• Patient Medical History Form
• Patient Records & Information Release Form
• Friends & Family Authorization Release Form
• HIPPA Form

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Payments Options

We want your care to be as accessible and affordable as possible. Before we ever begin treatment, we will discuss all of our fees and go over the financial arrangements available to you. We have developed a number of convenient payment options for you to choose from including CareCredit, which offers 3-, 6-, or 12-month interest-free payment plans or 12-, 24-, or 48-month extended payment plans. Ask about CareCredit when you call us or visit www.CareCredit.com. Of course, we are happy to file your insurance for you and always go out of our way to maximize your insurance benefits. We also accept MasterCard, Visa, American Express, Discover Card, Cash, and Checks.

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Insurance

Park Cedar Dentistry accepts benefits and files insurance claims, regardless of your insurance provider, on your behalf – saving you valuable time and money. We are In-Network with the following providers. If you have any questions, don’t hesitate to contact us for more information.