4626 West Jefferson Blvd. Fort Wayne, Indiana 46804
New Patient Forms
Please click the appropriate link below and enter your information. All of your information will be securely submitted to our office.
Financing
We know that dental treatment is an investment in your overall health and well being. Taking excellent care of you and your family is our number one goal. When it comes to finances, we want to make sure that we are communicating with you up-front regarding the costs, payment options, and any applicable insurance benefits. Before treatment, we will provide you with an estimate of the total fees to be expected. Please understand that this is an estimate only, treatment can change for a variety of unforeseen reasons. We will offer to submit a pre-estimate to your insurance as well so that you will be able to plan for your out of pocket costs. Every patient’s dental plan is different, and while we strive to help you interpret your dental benefits, you are ultimately responsible for the final cost of treatment for which insurance does not cover.
Options
Pre-Payment Discount
We offer a 5% discount for all treatment (exceeding $500) that is paid in full the day of your treatment. This is paid by cash or check (NO credit cards)
Split Payment
For patients diagnosed with treatment that exceeds $500 and requiring multiple visits, we have an option for splitting the payments. Half will be paid at the beginning of treatment and the remaining half at the following appointment.
Care Credit
Applying is easy and we are here to answer any questions you may have during the process. Patients who qualify can enjoy low monthly payments with little or no interest and no up-front costs.
Insurance
We accept Humana Gold and will happily assist you in filing insurance claims for the treatment provided.
Our knowledgeable benefit coordinators will help you maximize your dental benefits and minimize your out-of-pocket cost.
If you bring in a copy of your dental plan, our staff will be happy to help you interpret your dental benefits. If your dental plan later determines that you were not eligible for coverage, the balance becomes your responsibility. Please make sure to bring your insurance card and a form of ID the day of your visit.
*We do not accept Medicaid, Hoosier Healthwise, or HIP.
We accept a variety of payment choices, including cash, personal checks, major credit cards, third-party credit cards and dental financing options.
