Maintenance

PATIENT FORMS

New Patients:

We request that new patients print out required forms and complete them prior to their appointment. Please bring the completed forms to your appointment. If you are unable to print them out ahead of time. Please arrive 15 minutes early to complete your necessary health history forms, HIPPA Acknowledgement and Consent to Treat forms. You can also complete them on your computer and email them to us. 

Antibiotics may be required before certain dental procedures (including cleanings) for the following conditions:  joint replacements, Prosthetic cardiac valve, previous endocarditits, Cardiac transplantation recipients with cardiac valvular disease and some instances of Congenital heart disease.  Please check with your cardiologist, orthopedic surgeon or family doctor if you are unsure if you are required to do so.

If you have had recent radiographs (obtained in the last 12 months) from another dentist, please contact them and bring them to your first appointment or have them sent to us at:

Village Dental Center
PO BOX 327
Goodrich, MI  48438
dawne@villagedentalcenter.org
(810) 636-2808 phone
(810) 636-4010  fax

FINANCIAL POLICY:

We are committed to providing you the best care possible.  The goal is best achieved if everyone is aware of the financial policy, which is an agreement between the doctor and the patient.  Your clear understanding of the financial policy agreement is important to our professional relationship.

Payment is required at the time of service, including co-pay and deductible if you have dental benefit coverage.  We cannot predict or guarantee exactly what your benefit company will pay.  Any unpaid portion of claims will be your responsibility.  We accept cash, check, Visa, MasterCard, American Express and Discover Card.  Interest free monthly financial arrangements are available for large procedures with a 50% down payment.  If previous payment arrangements are not kept, a monthly late fee will apply.

APPOINTMENTS:

We are an appointment based office.  When you schedule an appointment with us we block a predetermined amount of time for you with the Doctor or Hygienist.  We will do our best to remind you of your upcoming appointment.  We ask for a 24 hour notice from you if you must reschedule your appointment.  If this policy is not respected, we reserve the right to charge a cancellation fee.

If you are unable to make appointments in advance we would be happy to place you on our call list for short notice appointments.

 DENTAL BENEFITS:

Introducing Our In-House Dental Plan! One Dental Plan For Your Entire Family. Our in-house discount plan provides affordability and easy access to quality dental care! With your Plan there are: No yearly maximums, No deductibles, No claim forms, No pre-authorization, and No waiting periods. Please ask about our dental in house plan when you come in. 

In addition, our office participates with Delta Dental PPO, and other PPO Benefit Providers. As long as your benefit plan does not restrict your choice of dentist, you will be able to use your benefits in our office.  If we are out of network, your co-payments may be higher.

For our patients with dental coverage, it is important for you to bring your benefit information with you.  As a courtesy, we will be happy to submit your claim to your insurance carrier for covered charges.  We feel a pre-treatment estimate should be requested from your insurance carrier prior to all major services.