Your First Visit
Welcome to Ericksen Dental Family Dentistry! Please bring the following with you to your first dental appointment:
• Completed Patient Information, Medical/Dental History and HIPPA Forms (download on the right)
• List of Medications and Medical Alerts
• Insurance card issued by your carrier (If your spouse is the responsible party please bring his/her id# or social security# and date of birth)
• If you currently pre-medicate for dental appointments due to medical history such as Mitral Valve, Joint Replacement, etc. please do so before coming in for your initial visit
• Anyone under the age of 18 must be accompanied by a parent or legal guardian for the initial consultation
Dental Forms
To save time at your first appointment, take a few moments to fill out our Patient Registration Forms and bring them with you on your first visit to our office:
Patient Information Form
Medical & Dental History Form
HIPPA Privacy Policy Form
Financing & Payment Options
At Ericksen Dental, we make payments for your dental services easy. In addition to cash, check, M/C, Visa and Discover payment options, we offer Short-Term In Office Financing and our own In-House Discount Dental Plan. We also work with Care Credit and Chase Health Advance.
Cash
Checks
Visa
MasterCard
Discover
Dental Insurance
Ericksen Dental accepts most insurance plans. Insurance coverage will be verified on your first visit and we are happy to file your dental insurance claims for you. Please remember that the information that we receive from your insurance carrier is never a guarantee and nothing is final until full payment is received. Please note that you are fully responsible for all fees incurred at our office. If you have questions about your insurance coverage please call our dental office experts and we will provide the information that you need to fully understand your financial obligations.
480-644-7777