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Payment/Insurance and New Patient Forms |
Insurance:
We accept most insurance plans. As a courtesy to our patients
we file your insurance claims and provide your insurance company
with all the necessary information needed to expedite the
process. Our trained and experienced administrative staff
prides itself in helping our patients maximize their insurance
benefits.
Payment:
In order to help you achieve your goal of a healthy mouth
and a beautiful smile, we offer payment plan options to suit
your budget:
- Care
Credit Medical/Dental Card - Care Credit offers
3, 6 and 12 month interest-free payment plans, and
extended financing up to 48 months. You can apply
in our office or apply
online.
- Chase
Health Advance offers no interest plans of 3,
6, 12, 18 and 24 months or choose an extended payment
plan for up to 48 months. Contact our office for details
- CITI
Health Card offers 3, 6, 12, and 18 month interest-free
payment plans, with low monthly payments, and no
annual fee. You can apply in our office or apply
online. .
- In-house financing: Interest-free option by dividing
the payment over the number of visits needed for
the treatment.
- 10% courtesy discount for full payment made at
the beginning of the treatment.
- Cash, Personal Check, Master Card, Visa and American
Express are accepted.
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| If you have any questions about your insurance
plan or payment options, please call us at (202) 363-0106. |
New Patient Forms:
If you would like to complete your registration forms before you arrive, you may download them by clicking below. The new patient forms are in PDF format. If you do not have Acrobat Reader, get a free copy by clicking on the link below. Also, after reading the Notice of Privacy Practices, print the Acknowledgement form below, sign it, and bring it in, too. 
 Welcome Letter (Acrobat PDF form)
Patient Registration and Medical History (Acrobat PDF form)
Oral Screening Consent Form (Acrobat PDF form)
Photography Release (Acrobat PDF form)
Notice of Privacy Practices (please read this before signing the Acknowledgement Form) (Acrobat PDF form)
Acknowledgement of Receipt of Notice of Privacy Practices (Acrobat PDF form)
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