New Patient Forms and Information
NEW PATIENTS MUST FILL THE FOLLOWING FORMS & BRING TO THEIR FIRST APPOINTMENT:
FORMS NEEDED FOR THE OFFICE NEW PATIENTS:
- New Patient Medical History Form
Patient Financial Terms and Condintions
- Consent for Testing
- Photo Consent
- Office Cancellation Policy Consent
- Oral Cancer Screening Consent (STRONGLY RECOMMENDED, but optional...a medical insurance card will be required to submit to insurance)
We recommened arriving 15 minutes early to accomodate parking and filling out the necessary forms. Thank you
Please be aware that appointments are time sensitive. If your appointment has been confirmed and you fail to show up there will be a charge. Failure to show up, be medicated or if you decide to leave the facility will result in a charge. Thank you.
A credit card will also be necessary as preauthorization of payment. When the services are rendered the card will be charged out.
ADDITIONAL FORMS FOR OTHER TREATMENTS AT THE OFFICE:
FORMS NEEDED FOR IN-OFFICE WHITENING:
FORM NEEDED WHEN HAVING AN EXTRACTION:
POST OP INSTRUCTIONS:
Extraction(s) (single or multiple teeth)
Dentures (complete and/or partial)
Tooth-Colored Fillings (Composites)/Crown & Bridge
FOR PATIENT’S FILE:
Acknowledgment of Receipt of Notice of Privacy Sheet
We accept the following PPO insurances in our office, and we would be glad to file claims on your behalf:
- Delta Dental
- United Concordia
- Dominion Dental
For payment, we accept cash, checks, Visa, MasterCard and Discover.
Now accepting patients through "DentalPlan".
Dr. Thapar-Dua also participates in the DDS Program (Donated Dental Services) through the MSDA (Maryland State Dental Association).