Prescott Dentistry Waiting Room

New Patient Registration

Below are the forms that you will need for your first visit to our office. Please fill out and submit the forms online below. If you prefer filling out our paperwork in office using our Patient Kiosk, please plan to arrive to your appointment 10 minutes early.

Please be advised that by using our online forms to contact our office, we are not establishing a doctor-patient relationship. As a user of this mode of communication and of our website, you assume all risks with placing confidential information into this portal. This form of communication is not intended for acute, emergency, or life-threatening health conditions. If you believe you are having a dental emergency, contact 911 or go to your nearest emergency department.

Prior to scheduling your appointment, please be sure to read this thoroughly:

It is the policy of Prescott Dentistry to require 48 hours advance notice for all appointment cancellations. All appointments are considered confirmed at the time that they are booked. In consideration of our patients time we do not double book our providers, therefor patients that miss appointments are of great concern to the providers at Prescott Dentistry. A missed appointment is a missed opportunity for another patient to receive the care that they need. In light of this, when a new patient "misses" or "no-shows" their first appointment at our office, we will not be able to re-schedule that time with our providers. You will need to find another provider for your dental care.

Fragrance Free Space

Financial Arrangements

Thank you for choosing Prescott Dentistry. Our primary mission is to provide conservative and preventative, high-quality dental care in a healing environment. We do this by focusing on compassionate service and by implementing biomimetic principles that result in lifelong oral health and the most comprehensive dental care available. An important part of the mission is making the cost of optimal care as easy and manageable for our patients as possible by offering several payment options. Prescott Dentistry is a fee for service office and requires payment at the beginning of your treatment. (If you choose to discontinue care before treatment is complete, your refund will be determined upon review of your case.)

Payment Options:

 

You can choose from:

  • Cash, Check, Visa, MasterCard or Discover
  • Convenient Monthly Payment Options¹ from CareCredit Healthcare Credit Card

    Allow you to pay over time

    No annual fees or pre-payment penalties
Patients with Dental Insurance

 

For patients with dental insurance we are happy to work with your carrier to maximize your benefit and provide you with the documentation you need to receive reimbursement for your treatment.

Even if you have Dental Insurance, you are responsible for your account, not your insurance company. Most plans are designed to pay a portion of the total cost of services based entirely on the premiums paid for the coverage as it is with any other type of insurance. The percentage covered is based on what the insurance carrier “allows” for a particular procedure, not what the dentist may actually charge. If there are questions regarding your coverage or the payment the insurance company has made, it is your responsibility to contact them for clarification. We are not a party to contract between you, your employer, and the insurance company and cannot be held responsible for benefits you may or may not receive. As a courtesy to you, we will submit a claim to your insurance company within one working day, but that is the extent of our responsibility as long as the claims are accurate. Because we are not contracted with your insurance company, we as that you pay the entire fee at the time of service and we will have your insurance company reimburse you directly.

Missed Appointment/ Cancellation Policy

 

For patients who miss or cancel appointments more than 3 times in a calendar year without 48-hour notice we may apply a $50 missed appointment fee to your account or ask that you pre-pay your appointments. Furthermore, for patients that we have made arrangements with to accept payments directly from your Insurance Company, this courtesy may be revoked either temporarily or permanently.

Prescott Dentistry charges $30 for returned checks.

¹Subject to credit approval

CareCredit

Apply for CareCredit