Please complete the following four forms. After you have entered your data on each form you may either click the submit button and the form will be emailed to our office, or you can print the forms and bring them into the office on your next visit.

New Patient Form

The Information requested on the New Patient Information form is important to our records and your health. Please fill the form out completely.

New Patient Information Form

Dental and Medical History Form

By filling out and signing this form you are providing us with the necessary dental and health information to provide you with the proper dental care.

Dental and Medical History Form

Consent and Disclosure Form

By signing this form, you consent to our use and disclosure of your protected health information to carry out treatment, payment activities, and healthcare operations.

Consent and Disclosure Form

Financial Policy Form

Information about our payment and insurance policies.

Financial Policy Form

Secure, Online Credit Card Payments

Make a payment by using our secure online credit card form. A simple and easy way to make a payment for your dental services. Just click the "Submit Online Payment" link below and enter your payment details in the form provided.

Submit Online Payment

Introduction

People always ask us how long should this last? In our office we strive for perfection and satisfaction. Which is why we are happy to provide you this retreatment policy, something few other offices offer. Let us remember that in today's technology almost everything we have learned is on the preventive side. Instead of going to the dentist every few years for "Drill, Fill and Bill," let's try preventive dentistry. If you spend 4 minutes in the morning and 4 minutes in the evening brushing, flossing and doing any other special treatments we have recommended and let us professionally clean your teeth, check for decay, apply a fluoride treatment, or apply sealants you can prevent most all disease. This is why our retreatment policy must be null and void it we don't see you for your regular 6 month check-ups. With 6 month check-ups your teeth and gums are winners!

Silver and Composite Fillings

When a tooth has a cavity, we remove the decay and fill the hole with a silver filling. The tooth is what supports the filling. The ideal is no more that 50% of the tooth. This allows half the tooth to support the filling. When you get a cavity that takes up 60% or more of the tooth then a crown in indicated. A crown covers the entire tooth and holds the tooth together. Sometimes we place a filling thinking there is enough tooth to hold the filling when actually there is not. The tooth then starts to break away because it can no longer support the filling. In this case we will credit the cost of the filling towards the cost of a crown and build-up. In addition, for a period of 3 years from the date of service, we will refund the cost of a silver filling or replace the filling due to breakage, or misfit at no cost to the patient. This is null and void if the patient does not maintain his/her 6-month continuing care cleaning appointments.

Crown or Bridge

For a period of 5 years from the date of service, we will refund the cost or redo a crown or bridge due to breakage or misfit at no cost to the patient.* This is null and void if the patient does not maintain his/her 6-month continuing care cleaning appointments. *Gold and porcelain crowns are the same for practically all cases except that porcelain can chip. Approximately one (1) out of every 100 porcelain crowns chips and need replacement. This will never happen with gold crowns. If your porcelain crown chips in the first five (5) years, we will replace it for free. However, if it chips after the five-year period it would cost you the regular fee for a new crown. This should be taken into consideration when choosing between a porcelain or gold crown.

Root Canals

Do root canals always work? No! A root canal is a therapy not a cure. It has a high success rate but 4% of them fail. If your root canal fails we will send you to an endodontist who specializes in root canals and why they fail.

Sealants

Dental sealants are thin plastic coatings that are applied to the chewing surfaces of the back teeth to prevent decay. Most tooth decay in children and adolescents occurs on the chewing surfaces of the back teeth or molars. This is because molars have irregular surfaces with pits and grooves which tend to trap food, bacteria and debris. Sealants flow into and coat these pits and grooves so that bacteria cannot multiply and cause decay. The teeth most likely to benefit from sealant application are the first and second molars just after they have erupted and before they have a had a chance to decay. Children between the ages of 5 and 14 benefit most from sealants. A sealant application can last for as long as five years and often longer. Sealants should be checked regularly and reapplied when they appear to have worn off. Because teeth are most susceptible to decay when they are young, preventing decay during the first 5 to 14 years after a tooth erupts is critical. This is null and void if the patient does not maintain his or her six-month continuing care cleaning appointments.

Is it covered by insurance?

Most insurance companies pay 100% for preventive procedures, 80% for restorative procedures like fillings, root canals, extractions, and 50% for crowns, bridges, dentures and braces. The most common non-coverage items would be sealants on bicuspids and implants. Some companies do cover these though. Have a ? Call and ask us. 801-921-7378.

What are the causes of an abscessed tooth?

The most common is decay. The tooth gets infected and abscesses. The other common way is through injury. Unlike other parts of the body that can swell and get lots of oxygen to the area, a tooth can not swell. The cells inside the tooth don't get enough oxygen and thus the cells begin to complain with pain and sensitivity. If it abscesses it is called a sterile abscess.

What can I do for a toothache?

See us as soon as you can. If that is not possible and the tooth is sensitive to cold, use over the counter medications like ambisol and numbs it.

Metals and Allergies

One out of every seven women and one out of thirty men have an allergy to nickel. We no longer use nickel-containing products. Please let us know if you are allergic to any other metals, including silver amalgam.

Why do I need a crown?

The most common reason for a person to need a crown is that too much of the tooth is missing. The existing filling should cover no more than two third across the top of the tooth, and replace none of the cusp.

What can I do about canker sores and cold sores?

There is something that can be done! For cold sore (those that break out on the lips and stay for two weeks) you should try Zovirax. This is an anti-viral medication that works very well for most people. It comes in a tube and is applied from the very beginning (the prodromal stage), even before you see it every four hours until it is gone.

For canker sores it's a little tougher. The cause is still unknown. However, palliative treatment can be done to make them more comfortable and decrease the time they hang around. Try the following:

• Canker compound, a mixture of topical anesthetic, antibiotic and a steroid. (Salmon Pharmacy)
• Aphthasol, a new prescription drug. You apply this topically.
• Avoid the foods that bring them on. For many people this means tomatoes, nuts or sometimes just stress.

How long can I wait before I have this work done?

The sooner you get your dental work done the better. The longer you put it off, the larger the lesions get. The larger they get the more expensive and painful they get.

How often should I have my teeth cleaned?

Most patients fit into a three to six month range. We can determine a schedule for you at you cleaning appointment. If you go too long, your gum tissues will begin to recede away from the build up of plaque and calculus. This can lead to other problems.

Does fluoride really help adults?

Fluoride helps adults topically, whereas in children they get fluoride built right into the permanent teeth as they develop.

How long will this take?

We know how long each procedure takes so we can schedule properly. You should notice that we usually run on time. Ask us about your appointment-we can tell you the expected length of your visit.

How much will this cost?

We are very sensitive to costs. Dentistry can be quite expensive. We check our fees with national surveys and find that we are at or below the national and regional averages for all of our procedures.

Are you an orthodontist?

I am a general dentist who performs simple orthodontics. Much like I do simple root canals and save the really tough ones for the endodontist. Or like the fact I remove most wisdom teeth but send the really tough ones or those who want to be put out, to an oral surgeon.

Do you take new patients?

YES! Unlike a physician, who gets swamped with new patients, a dentist gets someone done and they usually don't need much for years.

Can I make monthly payments?

YES, for up to three months. We are not a lending institution, but if you need more than three months to pay for your work, we have resources that lend money for dentistry for several years.

Will I be able to drive home?

If you have been pre-medicated with systemic medications, you should have someone to drive you home. If you've received a local anesthetic and had nitrous oxide, once you have breathed oxygen for several minutes, you will be able to drive your self home.

Is this going to hurt?

If you get enough anesthetic you should be comfortable during any procedure.

How can I prevent cavities?

Brush each tooth several times per day. Floss all of your teeth at least daily. Avoid frequent contact with refined sugar.

Do soft brushes really clean my teeth?

They may not stimulate your gums as much as harder bristled brushes, but they get into the hard places to reach and are more gentle on your gums and teeth.