Patient Information

YOUR FIRST VISIT WITH DR. QUINN FAMILY DENTISTRY

Dr. Quinn and our dental team work hard to make sure that your first visit is smooth and easy. We offer convenient scheduling and pledge never to overbook appointments so that you receive personalized treatment and never have to wait. We offer dental care for the entire family. Our friendly team makes it quick and seamless to fill out the appropriate paperwork and will walk you through your insurance and payment options. Click the links below to print and fill out paperwork before you visit our office for the first time.

NEW PATIENT FORMS

• Health History Form
• Financial Policy Form
• Notice of Privacy Practices
• Acknowledgment of Receipt of Notice of Privacy Practices

FINANCIAL POLICY

We accept cash, all major credit cards and Care Credit.

NO SHOW APPOINTMENTS:

• All non‐cancelled hygiene appointments will be charged a $25.00 service fee.
• All non‐cancelled doctor appointments will be charged a $50.00 service fee.
• These fees may be applied for cancellations within 24 hours of your appointment.
• Patients with three or more no show appointments may be subject to dismissal from the practice.

LATE APPOINTMENTS:

• Patients more than 10 minutes late may be required to reschedule and a service fee may be applied.

INSURANCE

• Your insurance is a contract between you, your employer and the insurance company. Not all services are a covered benefit in all contracts. Some insurance companies arbitrarily select certain services they will not cover.
• We work as an independent provider with most insurance companies. If services are not covered by your plan, payments are due in full at the time of your visit to our office.

MEDICAL RECORDS

• If a copy of your medical records is required, please allow a 72 hour time period for their preparation.
• The first 25 pages will be charged at $1.00 per page with $0.25 for each additional page.