Patient
Information
FORMS & FINANCING
So we can assist you in a timelier manner, please take a moment prior to your scheduled appointment to download our patient forms. Please have them completed and bring them to your scheduled appointment.
Download Your Forms
Included here are forms we recommend you download prior to your visit. Included are the Patient Registration & History Form, Notice of HIPPAA Privacy Act, Acknowledgement of Notice of Privacy Practices, and the Office Cancellation Policy.
PAYMENT OPTIONS
For your convenience, we accept cash, personal checks, money orders and major credit cards including, VISA, MasterCard & Discover. Payment is expected at the time services are performed. When more extensive dental care is necessary, extended financial arrangements can be made through a 3rd party financial institute like CareCredit.
INSURANCE
At Queen Dental Care Center, when it comes to financial services, insurance billing is offered for your convenience either electronically or with paper claims. We use the most up to date dental codes and dental terminology needed for reimbursement.
We will file all insurance plans for you if you have “out of network” benefits. It is your responsibility to check your insurance for “out of network” coverage. Having those benefits will allow you to go to the dentist of your choosing. We also participate in a % off program with both Cigna and Guardian, so please check with your respective insurance to see if your company falls into this category.
Please contact our dental office if you have any questions regarding the managed care or insurance plans that we can file.
