Patient Forms
New Patients
Please bring these completed forms with you when you come for your visit:
Existing Patients
- Patient Profile Form – Existing patients need to redo this form periodically. You will be advised if you need to bring this form.
- Covid-19 Questionnaire – Needed for every visit.
Financial Arrangements
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.
Dental Insurance
If you have dental insurance, you can expect us to help you get the maximum benefit to which you are entitled. We are a participating dental office for the following dental insurance plans:
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.
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.
Parking
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.
Privacy Statement
Our office complies with all aspects of the HIPAA (Health Insurance Portability and Accountability Act) of 1996, which is United States legislation that provides data privacy and security provisions for safeguarding medical information. To understand how Ferguson Dental Care manages your medical information and how you can get access to your medical information, review the Ferguson Dental Care Privacy Statement.