Forms & Insurance

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 are 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

Medical History Form

Financial / Insurance /Appointment Agreement

Notice of Privacy Practices (HIPPA)

Returning Pediatric Patient Forms

Medical History Update

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

Our Location

Find us on the map

Frederick, MD

Hagerstown, MD

 

Hours of Operation

Our Regular Schedule

Frederick, MD

Monday:

8:30 am-5:00 pm

Tuesday:

8:30 am-5:00 pm

Wednesday:

8:30 am-5:00 pm

Thursday:

8:30 am-5:00 pm

Friday:

Closed

Saturday:

Closed

Sunday:

Closed

Hagerstown, MD

Monday:

8:30 am-5:00 pm

Tuesday:

8:30 am-5:00 pm

Wednesday:

8:30 am-5:00 pm

Thursday:

8:30 am-5:00 pm

Friday:

Closed

Saturday:

Closed

Sunday:

Closed

  • "[Review for Frederick Pediatric Dentistry]
    Kate became nervous for her exam when she sat in the chair. Dr. Amigo changed her schedule and did an exam on my older daughter first. Because Kate saw Anna getting the exam she then agreed to go with the hygienist. The hygienist was so caring and gentle with Kate. I know their schedule got thrown off because of this but that change gave Kate the confidence to do the exam and I appreciate it greatly. Irma, the dental assistant even came out to give the girls prizes when we were about to leave which made their day. Thank you all for being flexible in order to provide a positive experience for my children."
    By Katherine Marshall on 09/23/2020
  • "[Review for Frederick Pediatric Dentistry]
    Felt very safe and comfortable with all the Covid-19 ins we waited in our car till they called us and told us to meet up at the door are temperatures were taken hand sanitizer was given no air tools were used one way in one way out they literally thought of everything they could to protect their staff and the kids. It was a very pleasant experience during very unpleasant times"
    By Shayla Leatherman on 08/19/2020
  • "[Review for Frederick Pediatric Dentistry]
    For being a pediatric practice, they really do make my 5 year old feel comfortable. They took all the proper COVID-19 safety measures, which made me comfortable as well. The staff is professional and friendly, and they truly do make coming to the dentist an enjoyable experience."
    By Aubrey Schemm on 07/22/2020
  • "[Review for Frederick Pediatric Dentistry of Hagerstown]
    great experience every time. My Kids had a great time.My son who was terrified of dentists did absolutely wonderful at this first visit!!! The dental hygienists are very professional and very good at their jobs. One can tell off the bat that they have great experience with kids! would recommend them every time. Keep up the great work!"
    By Anonymous on 09/22/2020
  • "[Review for Frederick Pediatric Dentistry of Hagerstown]
    I have always loved this dentistry! Very glad to still have them for a dentist for my youngest daughter, as her brother would only let Dr Joe look at and do anything to his teeth growing up. Then he's seen my middle child and she still continues to come here! I wish he or his office would see adults cause I'm SURE my son would definitely come back to see Dr Joe, as I would love for him to be my dentist as well. All the employees are so friendly and if need anything they are there to help out anyway they can! They make you as well as your children feel very comfortable."
    By Aaliyah Frisby on 08/26/2020
  • "[Review for Frederick Pediatric Dentistry of Hagerstown]
    definitely from arrival to departure, the attention is super good especially with the protocol for the Covid-19 100% recommended"
    By Karianys Santiago on 06/26/2020
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