Awesome Dental Care for the Elderly in Assisted, Memory Care and Long-term care communities

MEMORY CARE residents

Forms

   CLICK ON LINK BELOW TO BEGIN:                                                                     IF YOU HAVE ALREADY COMPLETED                                                                                                                                    OUR PAPERWORK AND ONLY NEED

                                                                                                                              TO MAKE A PAYMENT, CLICK BELOW

By clicking on the LEFT BUTTON, you will be taken to complete the following:

1.  New Patient Registration

2.  Informed Consent

3.  Notice of Privacy Practices (HIPAA)

YOU MUST COMPLETE ALL SECTIONS. 

WE CAN NOT SEE PATIENTS WITHOUT ALL SECTIONS BEING COMPLETE.

If you have Dental Insurance, all benefits are payable to you.  We do not participate 

in any dental plans.

NEW PATIENTS

IF YOU HAVE COMPLETED ALL SECTIONS AND WANT TO ONLY MAKE A PAYMENT, CLICK BELOW.