Insurance
We do not participate with HMO’S. Please check with your insurance carrier to confirm that we are a participating provider with your plan. It is your responsibility to know your own coverage. We cannot always make phone calls on your behalf to determine your eligibility or benefits prior to your appointment.
Most insurance plans still require you to pay a portion at your child's appointment.
As a courtesy on your behalf, we will submit claims to any insurance plan that has coverage for dental or orthodontics.
To prevent surprises, we encourage you to double check with your insurance company prior to your child's first visit.
Online Forms
Our office does everything possible to keep you, your children, and our staff safe. To minimize your time and “touch points” in the office, we now offer online registration and check in. We're asking all families to setup access to our patient portal and complete your registration online for the location you wish to call your dental home. You can fill out all necessary forms from the safety and comfort of your home prior to your appointment. Your responses will be safely and securely downloaded directly into our software, and any future forms will pre-populate with the answers you already gave. If you prefer, you can also click on the links and download a PDF of the form, print it out, and fill it out by hand. Just remember to bring it completed to your appointment..
For Frederick New Patient Online Forms Click Here
For Hagerstown New Patient Online Forms Click Here
Downloadable Forms
If you prefer paper, download these forms and fill them out prior to your arrival to help us see you faster.
New Pediatric Dentistry Patient Forms
Financial / Insurance /Appointment Agreement
Notice of Privacy Practices (HIPPA)
Returning Pediatric Patient Forms
Power of Consent Form (if someone other than the parent is bringing the child; i.e. grandparent)
Nitrous Oxide and Sedation Forms
Laughing Gas (Nitrous Oxide) Instructions
Oral Sedation Instructions
Orthodontic Forms
Ortho Health History - Under 18 Years Old
Ortho Health History - Adults