Patient Forms, Map and Directions to Washington Office
Your first visit to Dimples Dental Suite involves a few special steps so that we can get to know you. To understand what to expect, please read through this page. You'll find all the practical information you need, such as a map and directions to our office, practice hours, payment policies and more. There's also background information about our committed staff and our first visit procedures.
Dental health is the beginning to living a healthy and fulfilling life. Relaxation equally is an important first step is having a productive day or getting ready for a complex endeavor in life or career. Here at Dimples Dental Suite, our aim is to provide our clientele with the best possible start to living and being healthy. Our doctors and staff are here to open up the possibilities to wellness and confidence with a wonderful smile. Our mission is simple; provide stellar dental care to our clients and give them a reason to brighten the world with an awarding winning smile.
Please click the link below to complete and submit our forms electronically, so we can expedite your first visit:
Unfortunately, paper forms will not be accepted in our office.
What To Expect
All new patients are asked to arrive 15 minutes prior to their scheduled appointment to allow for insurance verification/presentation, forms completion, and registration. The first appointment consist of a meet and greet with dentist and team, comprehensive exam, radiographs, cleaning and treatment plan presentation. Patients are expected to bring their insurance card and government issued identification to their initial appointment.
As a condition of treatment within Dimples Dental Suite, financial arrangements must be made in advance. The practice depends upon reimbursement from patients for the costs incurred in their care. Financial responsibility on the part of each patient must be determined before treatment. Before any dental treatment begins, the patient and/or responsible party will receive a consultation regarding that appointment's treatment and costs. We attempt to keep our fees as low as possible while still providing quality care in our office. Prompt payments enable us to keep administrative costs associated with billing and collection efforts lower for everyone. Actual treatment costs are based on the Dimples Dental Suite or Insurance Carrier Fee Schedule, whichever is better, that are in effect when a procedure is started. We accept Cash, CareCredit, American Express, Discover, VISA, and MasterCard for payment. For procedures that take multiple appointments to complete, payment may be split up over number of appointments required with a deposit. Should you require monthly installments, please consult our dental team. Only written agreements/arrangements are honored. Any fee estimates for dental care can only be extended for a period of six months from the date of the patient examination. In consideration for the professional services rendered by the practice, patient must agree to pay the charges for the services at the time of treatment, or within five (5) days of billing if credit is extended. In addition, patients will have to agree that the charges for services shall be as billed unless objected to, in writing, within the time payment is due.
As a courtesy to our patients with dental insurance, we currently accept, we will file your insurance claim and allow you to pay only your deductible and/or co-payment as services are rendered. Your signature below denotes assignment of insurance benefits to the doctor. Any payments received by the doctor from your insurance company will be credited to your account, or refunded to you, if you have paid the dental fees incurred. When the reimbursement check is required to be sent to you and the insurance company is unwilling to pay us directly, we ask that you pay the full balance the day the services are rendered and we will file your insurance for you. Please remember that the contract is between you and your insurance company and your total balance in our office is always your responsibility. We make every effort to give you an accurate estimate of what your portion of our fees will be based on the information provided to us from you and your dental insurance provider. Should the actual payment from your insurance company be different than originally estimated, you will be billed or credited according to the status of your overall account. Any dispute regarding reimbursement or the amount of reimbursement is between you and your insurance carrier. We strongly advise you to familiarize yourself with any restrictions and all details associated with your insurance policy prior to initiating treatment.
Past Due Accounts Policy
Account aging begins the day your charges are incurred and a late fee of $10.00 per month on the unpaid balance will be charged on all accounts exceeding 60 (sixty) days, unless previously written financial arrangements are satisfied. Again, in an effort to keep administrative costs associated with billing and collection efforts low, we require a credit/debit card to be on file to pay overdue balances (form will be provided). Accounts that are 120 (one hundred twenty) days past due shall be turned over to a third party collection agency or small claims. This action will result in an additional fee of 45% of your unpaid balance being added to your account (including late fees). We will do so only if all other efforts to collect your unpaid balance within 120 days have failed. In addition, if your account is sent to a third party collection agency or small claims, you will be responsible for the additional costs not limited to court costs and attorney fees.
Appointment Cancellation/No Show-No Call Policy
When you reserve a time with us please make every attempt to make your appointment. We do not "double book" as many offices do. This time is set aside specifically for you. You will receive an email, phone call or text message reminding you of your appointment 24 to 48 hours prior to your appointment. When you receive this message, please call, text or email us to confirm the time that you have already reserved with us. If we have not heard back from you by the close of business (5pm) the day prior to your reserved time, we will take your appointment off of our schedule. We have a 1-BUSINESS DAY cancellation policy. If you need to change or reschedule your reserved time with us, please give us at least a 1-BUSINESS DAY notice so that we will be able to fill this time with others waiting for treatment. If your appointment time with us is on Monday, please confirm with us by Friday, etc. If you cancel, fail to show for your confirmed appointment, or you arrive excessively late and treatment cannot be completed as planned, we recover our lost opportunity and associated costs for having our staff on standby with a Broken Appointment Fee of $50.00. This may sound harsh, but please understand that if you have THREE broken appointments, we reserve the right to release you as a patient and ask that you seek treatment at another Dental Practice. Thank you for understanding this policy.
LATE ARRIVAL: If you are over 15 minutes late for your appointment, we reserve the right to reschedule your appointment for a later time. The Broken Appointment Fee of $50.00 will apply to this as well. Please understand that we strive to stay on time for your appointment as well as those patients that follow you.
ARRIVAL WITH ELECTION NOT TO HAVE SERVICES RENDERED: We do not "double book" as many offices do; therefore, time was set aside specifically for you. If you elect not to receive treatment upon arrival and/or placement in treatment room, the Broken Appointment Fee of $50.00 will apply.