New Patient Information

We welcome you to our practice, and we are honored that you are considering us for your dental care. We are looking forward to meeting you. The following forms allow us to get to know you better, and to help make your visit to us pleasant and organized. It is very important that you return this information to us before your first appointment with us. Medical conditions that are unknown to us may prevent us from performing a comprehensive exam. Knowing your past dental history and your goals allows us to formulate treatments that are tailored to your desires. Most importantly, having the most recent x-rays and information from your previous dentist may save you time and the costs of retaking them if they are current enough. By receiving this information prior to your appointment, we can even enter insurance benefits into our computer system so that we can estimate what it will cover for you. This can be done in several ways.

1. You can print out the forms and send them to us in the mail. Our address is:

Dental Visions 193 Kinsley Street, Suit 105 Nashua, NH 03060

2. You can print out the forms, and fax them. Our Fax number is (603) 595-8577

3. You can e-mail them to us at Info@NEDentalVisions.com

Patients with Dental Insurance

We are pleased that you have a dental co-payment insurance policy. We will gladly submit your dental claims and work with you to maximize you benefits on a yearly basis. We ask you to keep several important facts in mind.

1. We work 100% for you. We do not take part in any insurance programs. We will gladly submit your dental claims and work with you to maximize your benefits, but we do not want to be controlled by insurance companies. Normally, in our office, you can count on your insurance company paying 25-50% of the total fee (up to your maximum) for covered services provided in a high quality private practice such as ours. The insurance companies pay their percentage off of a “Usual and Customary Fee”, which each of them establishes. This fee is different with every insurance company, and even different within the same insurance company. Different levels of benefits are offered to employers by each insurance company. The Usual and Customary fee may differ, depending on the plan chosen. It is important to realize that the "Usual and Customary Fee" is what the insurance companies allow for coverage, not what is actually a usual, average or customary fee that dentists actually submit. Dental insurance must be looked at as an aid, not as something that is expected to pay for high quality work.

2. We believe that a cooperative effort between you and our office will result in a dental service that we are proud to render and you are pleased to receive. We want to meet your needs in a way that adds significant value to your life and to ours as well. We will do everything possible to make our type of treatment affordable for you.

Dental Forms

	Adobe	Microsoft Word
Patient Information Form
Dental History
Office Commitments
HIPPA
Acquaintance form
Request for Release
Authorization for Release