New Patient Forms
The following forms are provided to our patients to download.
Please print and complete the forms and bring them to your appointment.
- Patient Registration Form
- Healthcare Release Form
- Privacy Policies
- Acknowledgement of Receipt of Statement of Privacy Practices
If you have questions about any of the paperwork, please give us a call at (509) 946-9313 and our staff will be happy to help you.
Insurance & Financial Policy
If you have dental insurance we will help you determine the coverage you have available. In order to best assist you, it is important that you submit your dental and/or medical insurance information to us with your New Patient Forms a minimum of two business days prior to your scheduled appointment. This allows us time to contact your insurance company and obtain a breakdown of the benefits you or your employer purchased from the company.
Should you be diagnosed with treatment services, we will be able to provide you with a detailed plan which will give you an estimate of how much your insurance company may pay for each procedure, as well as the portion you will be expected to pay at the time of service.
Professional care is provided to you, our patient family, and not to an insurance company. The insurance company is responsible only to the patient as a benefit from the individual or employer plan purchase, and the patient is responsible to the doctor. We will assist you every way we can in filing your dental or medical claim, and handling insurance questions from our office on your behalf.
In an effort to reduce the cost to you, the patient, while maintaining the highest level of professional care, we have established the financial policy as follows:
• Payment of any account balance is due in full within 20 days of statement date
• We gladly accept Visa, Discover, American Express, or MasterCard payments
Fees & Policies
Missed Appointment Fee
We strive to schedule an appropriate time for each patient family that visits Viewpoint Dentistry, taking into account the individual needs of each child. While we understand that emergencies happen, and it’s difficult to plan for the unexpected, it’s important that we respect the time of our staff, as well as those patients who may be waiting for an appointment with us.
Therefore, our missed appointment fees are as follows:
• $100.00 per scheduled family member
Past Due Payment Fees
Accounts that are past due will accrue a finance charge of 16.5% (after insurance payments have been applied). If your account is 90 days or more past due, it may be referred to a third-party for review.