Patient Forms & Resources
To expedite your next appointment, please fill out the Patient Information and HIPAA forms below. You may complete these forms online—they will be sent directly to our office—or you may download, print, complete, and bring them with you to your scheduled appointment.
If you have any questions prior to visiting our office, please do not hesitate to contact us. We are happy to discuss your concerns regarding patient records, what to expect, and insurance or billing questions.
New Patient No Show/Cancellation Policy
Medical Release Authorization
Make Online Payment
Do you accept my insurance?
We accept any insurance that allows you to choose your own provider of service (dentist). If you are limited to a list of providers, we will probably not be on that list.
What if I have a list of dentists and I am also allowed to choose someone not on that list?
This is referred to as “in-network” and “out-of-network” coverage. An in-network provider is contracted with that insurance company. An out-of-network provider has chosen not to contract with that insurance company. There may be a difference in the benefits you will receive, usually that difference is minimal. We recommend you find out what that difference is before you make any treatment decisions.
Are you contracted in-network with any insurance?
We are a “premier” provider for Delta Dental, only.
“I believe that it is not in the patient’s best interest to be treated according to what the insurance company dictates. Each patient must receive treatment based according to their individual dental needs and not according to contracted terms. I hold myself accountable for the highest quality of care available and I will not compromise that standard.” – Dr. Robert C. Brei, D.D.S.
Financing & Self-Pay
We work with patients to determine the best course of action for your health and budget needs. Our office has created phased plans of treatment to achieve optimal care, as well as financial plans that are comfortable for the patient.
Unless other arrangements have been made, we ask that patients pay their portion of the fee on the day of service. It is also your responsibility to pay any balance not paid by your insurance company.
For Our New Patients
We Welcome All Ages and Smiles!
Our office offers full-service general and cosmetic dentistry to help you maintain and achieve your ideal dental health.
What to Expect During Your First Visit
- Personalized care
- A comprehensive exam that allows our staff to fully understand your dental history, current concerns, and future needs
- Premiere patient suites
- State-of-the-art equipment
- A relaxing environment with blankets, pillows, television choices, back massagers, and a welcoming staff to maximize the comfort of your visit