Patient Information

New patients please bring this completed form with you when you come for your visit. Existing patients need to redo this form periodically. You will be advised if you need to bring this form.

• Patient Profile Form

Parking for our office is available behind our office, on the street in front of our office, or in the municipal lot behind the Fairwinds Deli, across the street and slightly west of our office.

Our fees are competitive with other providers of high-quality dental care in this area. It is our office policy to receive payment for services at the time of service unless other arrangements have been agreed upon. We accept personal checks and VISA, MasterCard, American Express, Discover, and cash, of course. In the event your planned treatment will result in fees exceeding $2,000, we may consider a mutually acceptable schedule of payments to assist you with budgeting. 

If you have dental insurance, you can expect us to help you get the maximum benefit to which you are entitled. If you have other types of dental insurance, we will accept assignment of benefits for most plans. However, fees for some services may not fall within a particular plan’s definition of “usual and customary,” and you will be responsible for the difference.

We are a participating dental office with the insurers described below.

Ferguson Dental Care is a participating dental office for the following Aetna dental insurance plans:

•  Aetna HealthFund/DentalFund plans
•  Aetna Individual Advantage Dental PPO
•  Aetna Dental Access plan
•  Aetna Dental EPP plans
•  Aetna Dental PPO/PDN plans
• Other Aetna plans

Ferguson Dental Care is a participating dental office for the following Cigna dental insurance plans:

• Cigna Dental PPO plan
• Cigna Radius Network plans

Ferguson Dental Care is a participating dental office for the following Delta dental insurance plans:

• Delta Dental Premier plan

Ferguson Dental Care is a participating dental office for the following Guardian dental insurance plans:

• Guardian Dental PPO plan

Ferguson Dental Care is a participating dental office for the following Horizon Blue Cross/Blue Shield dental insurance plans:

• Horizon Blue Cross/Blue Shield Dental Traditional plan
• Horizon Blue Cross/Blue Shield Dental Option plan