
New Patient Forms
- Health History/Insurance Information
- Financial Policy
- Notice of Privacy Practices HIPAA
- Acknowledge of Privacy Practices HIPAA
If you do not have AdobeReader® installed on your computer, Click Here To Download.
PAYMENT OPTIONS
To enable greater access to care, we offer our patients a cash payment discount incentive and options for outside financing. Summit View Periodontics accepts most major credit cards. We can offer immediate financing options for your care through companies such as CareCredit and Wells Fargo Health Advantage.
INSURANCES
Summit View Periodontics accepts most major Preferred Provider Organization (PPO) insurances and indemnity programs. We will aid you in coordinating therapy with your insurance carrier. Every attempt to ensure accuracy is made. Knowledge of each patient’s particular dental insurance program and payment for services rendered is ultimately the responsibility of the patient. Please contact our office for a current list of accepted programs.
The associated fees for your treatment will be provided at the end of your preliminary examination. Due to the complex nature of certain treatment needs and timing of your care, these fees can vary. Our schedule of fees will be reassessed semiannually. Your existing treatment plan is guaranteed not to change for ninety days from the day of creation.