Patient Info

First Visit

When you arrive for your first visit, please be prepared to complete all insurance and health information forms that will allow us to begin your dental treatment. We will ask you to fill out several forms that will get you acquainted with our office.
Your initial exam will last approximately one hour. We will take a series of x-rays and complete a full dental exam.
New Patient Forms
To help us with your chart, please download and print these forms, fill them out and bring them to your first appointment.

FAQ

Q. How often should I see a dentist?
A. The American Dental Association (ADA) guidelines recommend visiting a dentist at least twice a year for a check-up and professional cleaning. Our office also recommends a minimum of two visits per year.

Q. What should I expect during my appointment?
A. One of our staff members will compile your medical and dental history during your first visit. We will then examine your teeth and gums, screen you for oral cancer, make X-rays of your teeth as needed and complete a TMJ (temporomandibular or jaw joint) exam. After we review your dental profile, we will discuss a diagnosis with you. If treatment such as a root canal (endodontics), braces (orthodontics) or oral surgery is needed, we will plan to treat you in our office or refer you to a specialist. We will discuss your options for treatment and fee payment and help you determine the best plan to fit your needs.
During regular follow-up visits, we will examine your teeth and gums, screen you for oral cancer, clean your teeth and make plans for treatment, as needed. We will discuss any pain or problems you may be experiencing and answer any questions you may have.

Q. What does "painless dentistry" mean?A. Painless dentistry is a means of ensuring your total experience in our office is as stress-free and pain-free as possible. We will discuss treatment options that may require no local anesthetic and whenever possible, alleviate pain by the means most comfortable to you.

Q. What if I have an emergency?
A. Please call our office as soon as you determine that you have a dental emergency. We will be glad to work you in to our schedule if you have a dental emergency during regular business hours. After hours, over the weekend and during holidays, please call our office for the doctor's emergency contact number.

Q. Are payment plans available for my dental treatment?
A. Yes. We accept many types of dental insurance and will process your claim for you upon receipt of your co-payment. We offer financing through CARECREDIT.com and also accept most major credit cards.

Q. Can the dentist whiten my teeth?
A. There are several methods available for bleaching the teeth: in-office, at night or daily. One session of in-office bleaching generally lasts one and a half to two hours, and you can read or relax during the treatment. For overnight bleaching, we make an impression of your teeth and create a mouthguard that fits your bite. Each day you fill the mouthguard with a small amount of bleaching gel and wear it overnight or for a few hours during the day. The nightly bleaching process takes approximately two weeks.
Other over-the-counter daily bleaching products are available, but it is important to use any bleaching product only under the supervision of a dentist. To achieve the whitening results you desire, the ADA recommends that you seek the professional advice of a dentist, including examination and diagnosis of the cause of tooth discoloration, before you begin any bleaching program.

Q. What if I have a gap in my teeth, a chipped tooth or teeth that do not respond to normal bleaching methods?
A. We have many different procedures that can help these problems. Porcelain veneers are designed to look like your natural teeth and are individually attached to the fronts of your existing teeth. Veneers can be positioned to close gaps. Bonding utilizes a composite material made of plastic to fill in areas of your teeth and correct chipping and shape problems. Both porcelain veneers and bonding are color-matched to the rest of your teeth.

Cleanings

Bi-annually, you should schedule a routine dental cleaning. During this visit, one of our dental hygienists will remove plaque from your teeth, especially from places where your brush can't reach, such as underneath the gum line and in-between teeth. We will then clean & polish your teeth and apply fluoride, if eligible, to help protect your teeth once you leave the office.
Fluoride is a relatively recent but important advancement in dental and oral health. Studies consistently show that a moderate but consistent exposure of teeth to fluoride helps strengthen and rebuild tooth structure, and helps prevent future decay.
If you are due for your dental cleaning, please call our office to an appointment.

Brushing and Flossing

Use a toothbrush with soft bristles and a small strip of fluoride toothpaste. When you brush your teeth, move the brush in small circular motions to reach food particles that may be under your gum line. Hold the toothbrush at an angle and brush slowly and carefully, covering all areas between teeth and the surface of each tooth. It will take you several minutes to thoroughly brush your teeth. Brush up on the lower teeth, down on the upper teeth and the outside, inside and chewing surface of all of your front and back teeth. Brush your tongue and the roof of your mouth before you rinse.
Brush your teeth four times daily to avoid the accumulation of food particles and plaque:

  • In the morning after breakfast
  • After lunch or right after school
  • After dinner
  • At bedtime

As soon as the bristles start to wear down or fray, replace your toothbrush with a new one. Do not swallow any toothpaste. Rinse your mouth thoroughly with water after you finish brushing. It is important to carefully floss and brush daily for optimal oral hygiene.

Flossing

For areas between the teeth that a toothbrush can't reach, dental floss is used to remove food particles and plaque. Dental floss is a thin thread of waxed nylon that is used to reach below the gum line and clean between teeth. It is very important to floss between your teeth every day.
Pull a small length of floss from the dispenser. Wrap the ends of the floss tightly around your middle fingers. Guide the floss between all teeth to the gum line, pulling out any food particles or plaque. Unwrap clean floss from around your fingers as you go so that you have used the floss from beginning to end when you finish. Floss behind all of your back teeth.
Floss at night to make sure your teeth are clean before you go to bed. When you first begin flossing, your gums may bleed a little. If the bleeding does not go away after the first few times, let a staff member know at your next appointment.
Insert button "Request an Appointment" custom form.

Emergency Info

Tooth Ache
Begin by cleaning around the sore tooth meticulously. Using warm salt water, rinse the mouth to displace any food trapped between teeth. Under no circumstances should you use aspirin on the aching tooth or on the gum. In the event of facial swelling, apply a cold compress to the area. For temporary pain relief, acetaminophen is recommended. Please contact us for an appointment if the pain persists more than a day.
Cut or Bitten Tongue, Lip or Cheek
Ice can be applied to any bruised areas. For bleeding, apply firm (but gentle) pressure with sterile gauze or a clean cloth. If the bleeding does not stop with pressure or continues after 15 minutes, go to an emergency room.
Broken Braces and Wires
Remove a broken appliance only if it comes out easily. If it is lodged or painful to remove, cover any protruding edges with wax, cotton balls, gauze or chewing gum. Do not remove any wire caught in the gums, cheek or tongue. See a dentist immediately. Emergency attention is usually not required for loose or broken appliances that cause no discomfort.
Broken Tooth
Rinse the area with warm water. Put a cold compress over the facial area of the injury. Recover any broken tooth fragments. Seek immediate dental attention.
Knocked Out Permanent Tooth
Recover the tooth, making sure to hold it by the crown (top) and not the root. Rinse, but do not clean or handle the tooth more than necessary. Reinsert the tooth in the socket, and hold it in place using a clean piece of gauze or cloth. If the tooth cannot be reinserted, carry it in a cup containing milk or water. Because time is essential, see a dentist immediately.
Possible Broken Jaw
In the event of jaw injury, tie the mouth closed with a towel, tie or handkerchief. Go immediately to an emergency room.
Bleeding After a Baby Tooth Falls Out
Fold a piece of gauze and place it (tightly) over the bleeding area. Bite down on the gauze for 15 minutes. If bleeding continues, see a dentist.
Cold or Canker Sores
Over-the-counter medications will usually provide temporary relief. If sores persist, visit your dentist.

Privacy Policy

Effective April 14, 2003
This notice describes how medical information about you may be used and disclosed and how you can obtain access to this information. Please review it carefully.

Introduction
We are required by law to maintain the privacy of "protected health information." "Protected health information" includes any identifiable information that we obtain from you or others that relates to your physical or mental health, the health care you have received, or payment for your health care.
As required by law, this notice provides you with information about your rights and our legal duties and privacy practices with respect to the privacy of protected health information. This notice also discusses the uses and disclosures we will make of your protected health information. We must comply with the provisions of this notice, although we reserve the right to change the terms of this notice from time to time and to make the revised notice effective for all protected health information we maintain. You can always request a copy of our most current privacy notice from our office.

Permitted Uses and Disclosures
We can use or disclose your protected health information for purposes of treatment, payment and health care operations.
Treatment means the provision, coordination or management of your health care, including consultations between health care providers regarding your care and referrals for health care from one health care provider to another. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. Therefore, the doctor may review your medical records to assess whether you have potentially complicating conditions like diabetes.
Payment means activities we undertake to obtain reimbursement for the health care provided to you, including determinations of eligibility and coverage and other utilization review activities. For example, prior to providing health care services, we may need to provide to your insurance carrier (or other third party payor) information about your medical condition to determine whether the proposed course of treatment will be covered. When we subsequently bill the carrier or other third party payor for the services rendered to you, we can provide the carrier or other third party payor with information regarding your care if necessary to obtain payment.
Health Care Operations mean the support functions of our practice related to treatment and payment, such as quality assurance activities, case management, receiving and responding to patient complaints, physician reviews, compliance programs, audits, business planning, development, management and administrative activities. For example, we may use your medical information to evaluate the performance of our staff in caring for you. We may also combine medical information about many patients to decide what services are not needed, and whether certain new treatments are effective.

Disclosures Related To Communications With You Or Your Family

We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you or relate specifically to your medical care through our office. For example, we may leave appointment reminders on your answering machine or with a family member or other person who may answer the telephone at the number that you have given us in order to contact you.
We may disclose your protected health information to your family or friends or any other individual identified by you when they are involved in your care or the payment for your care. We will only disclose the protected health information directly relevant to their involvement in your care or payment. We may also use or disclose your protected health information to notify, or assist in the notification of, a family member, a personal representative, or another person responsible for your care of your location, general condition or death. If you are available, we will give you an opportunity to object to these disclosures, and we will not make these disclosures if you object. If you are not available, we will determine whether a disclosure to your family or friends is in your best interest, and we will disclose only the protected health information that is directly relevant to their involvement in your care.
We will allow your family and friends to act on your behalf to pick up prescriptions, medical supplies, X-rays, and similar forms of protected health information, when we determine, in our professional judgment, that it is in your best interest to make such disclosures.

Other Situations

Organ and Tissue Donation. If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

Military and Veterans. If you are a member of the Armed Forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.Public Health Risks. We may disclose medical information about you for public health activities. These activities generally include the following:

  • To prevent or control disease, injury or disability
  • To report births and deaths
  • To report victim of abuse, neglect, or domestic violence
  • To report reactions to medications
  • To notify people of product, recalls, repairs or replacements
  • To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition

Health Oversight Activities. We may disclose medical information to federal or state agencies that oversee our activities. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws. We may disclose protected health information to persons under the Food and Drug Administration's jurisdiction to track products or to conduct post-marketing surveillance.

Lawsuits and Disputes. If you are involved in a lawsuit or dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in a response to a subpoena, discovery request or other lawful process by someone else involved in the dispute.

Law Enforcement. We may release medical information if asked to do so by a law enforcement official:
In response to a court order, subpoena, warrant, summons or similar process
To identify or locate a suspect, fugitive, material witness, or missing person
About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement
About a death we believe may be the result of a criminal conduct
About criminal conduct on our premises
In emergency circumstances to report a crime; the location of the crime or victims or the identity, description or location of the person who committed the crime
Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients to funeral directors as necessary to carry out their duties.

Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary for the institution to provide you with health care, to protect your health and safety or the health and safety of others, or for the safety and security of the correctional institution.

Serious Threats. As permitted by applicable law and standards of ethical conduct, we may use and disclose protected health information if we, in good faith, believe that the use of disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

Disaster Relief. When permitted by law, we may coordinate our uses and disclosures of protected health information with public or private entities authorized by law or by charter to assist in disaster relief efforts.

Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients to funeral directors as necessary to carry out their duties.

Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary for the institution to provide you with health care, to protect your health and safety or the health and safety of others, or for the safety and security of the correctional institution.

Serious Threats. As permitted by applicable law and standards of ethical conduct, we may use and disclose protected health information if we, in good faith, believe that the use of disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

Disaster Relief. When permitted by law, we may coordinate our uses and disclosures of protected health information with public or private entities authorized by law or by charter to assist in disaster relief efforts.
Your Rights
1.You have the right to request restrictions on our uses and disclosures of protected health information for treatment, payment and health care operations. However, we are not required to agree to your request.
2.You have the right to reasonably request to receive communications of protected health information by alternative means or at alternative locations.
3.Subject to payment of a reasonable copying charge as provided by state law, you have the right to inspect or obtain a copy of the protected health information contained in 3.your medical and billing records and in any other practice records used by us to make decisions about you, except for:
Psychotherapy notes, which are notes recorded by a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint or family counseling session and that have been separated from the rest of your medical record
Information compiled in a reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding.
Protected health information involving laboratory tests when your access is required by law
If you are a prison inmate and obtaining such information would jeopardize your health, safety, security, custody, or rehabilitation or that of other inmates, or the safety of any officer, employee, or other person at the correctional institution or person responsible for transporting you
If we obtained or created protected health information as part of a research study for as long as the research is in progress, provided that you agreed to the temporary denial of access when consenting to participate in the research
Your protected health information is contained in records kept by a federal agency or contractor when your access is required by law
If the protected health information was obtained from someone other than us under a promise of confidentiality and the access requested would be reasonably likely to reveal the source of the information
We may also deny a request for access to protected health information if:
A licensed health care professional has determined, in the exercise of professional judgment, that the access requested is reasonably likely to endanger your life or physical safety or that of another person
The protected health information makes reference to another person (unless such other person is a health care provider) and a licensed health care professional has determined, in the exercise of professional judgment, that the access requested is reasonably likely to cause substantial harm to such other person
The request for access is made by the individual's personal representative and a licensed health care professional has determined, in the exercise of professional judgment, that the provision of access to such personal representative is reasonably likely to cause substantial harm to you or another person
If we deny a request for access for any of the three reasons described above, then you have the right to have our denial reviewed in accordance with the requirements of applicable law.
4. You have the right to request a correction to your protected health information, but we may deny your request for correction, if we determine that the protected health information or record that is the subject of the request:
Was not created by us, unless you provide a reasonable basis to believe that the originator of protected health information is no longer available to act on the requested amendment

  • Is not part of your medical or billing records
  • Is not available for inspection as set forth above
  • Is not accurate and complete
  • In any event, any agreed upon correction will be included as an addition to, and not a replacement of, already existing records.

5. You have the right to receive an accounting of disclosures of protected health information made by us to individuals or entities other than to you for the period provided by law, except for disclosures:

  • To carry out treatment, payment and health care operations as provided above
  • To persons involved in your care or for other notification purposes as provided by law
  • For national security or intelligence purposes as provided by law
  • To correctional institutions or law enforcement officials as provided by law
  • That occurred prior to April 14, 2003
  • That are otherwise not required by law to be included in the accounting

6. You have the right to request and receive a paper copy of this notice from us.
7. The above rights may be exercised only by written communication to us. Any revocation or other modification of consent must be in writing delivered to us.

Complaints
If you believe that your privacy rights have been violated, you should immediately contact our Practice or our Privacy Officer. All complaints must be submitted in writing. We will not take action against you for filing a complaint. You also may file a complaint with the Secretary of Health and Human Services.