1010 E. University Dr.
Mesa, AZ 85203

Ericksen Dental in Mesa AZ Dental Patient
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Facebook Drawings


Downloadable Patient Forms

New Patient Packet

Individual Forms:
Patient Information Form
Medical & Dental History Form
HIPPA Privacy Policy Form
Financial/Appointment Policies
Appointment Reminders
Consent For Composite Fillings
Consent For Payment


Mesa Dentist Appointment

Professional Teeth Whitening


Mesa Family Dentist

Your First Visit

Welcome to Ericksen Dental Family Dentistry! Please bring the following with you to your first dental appointment:

• Completed New Patient Packet
• 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 print and fill out our Patient Registration Forms and bring them with you on your first visit to our office:

New Patient Packet


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.


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.

Insurance companies we currently participate with:

This is only a partial list of the many insurance companies we participate with!

* not directly contracted, but participate with specific contracted fee schedules
+ a fee schedule that participates with multiple insurance companies
~ insurance allows our usual and customary fee schedule

Cancellation Policy
Patients who do not cancel their appointment within 24 hours will be charged a $40.00 cancellation fee.