NEW PATIENT REGISTRATION FORMS
You may pre-register with our office by filling out our secure online Patient Registration Form by clicking the links below. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information and be sure to download and print a completed copy for yourself. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.
IMPORTANT: If you do not pre-register with us online, please arrive at least 15 minutes prior to your scheduled appointment time to allow sufficient time required for the registration process.
Making Your Appointment Easy
Our friendly and compassionate staff is dedicated to you and will ensure your comfort and quality care. Your initial appointment will consist of a consultation explaining your diagnosis and treatment options. Surgery can be performed the same day as the consultation, however, a complex medical history or treatment plan will require an evaluation and a second appointment to provide treatment on another day. Please alert the office if you have a medical condition that may be of concern prior to surgery (i.e., diabetes, high blood pressure, artificial heart valves and joints, rheumatic fever, etc.) or if you are currently taking any medications (i.e., heart medications, blood thinners, bisphosphonates for osteoporosis, etc.).
We ask that you bring the following information at the time of your initial consultation:
A valid photo ID
Your surgical referral slip and any x-rays if applicable.
A list of medications you are presently taking.
If you have medical or dental insurance, bring the necessary information and completed forms. This will save time and allow us to help you process any claims.
A copy of your completed Patient Registration Form if completed online
FINANCIAL INFORMATION
We offer a variety of payment options to meet your needs. We accept Care Credit, all major credit cards, personal checks and cash. If you have any questions about financing or payment, please call our office! We will thoroughly explain your choices and will work hard to accommodate your needs.
If we are billing your insurance for you, your estimated portion is due before service is rendered. This includes deductibles and non-covered services. If you do not have dental insurance, your total payment is due before service is rendered. If your insurance pays less than expected, you will receive a monthly statement for the balance. If your insurance overpays, we will send you a refund check.
INSURANCE INFORMATION
Our team is happy to bill most dental insurance providers for you. Before your appointment, we will verify your dental insurance, and based on the information given to us, estimate your portion of the payment. Since the information given to us by your insurance company is not a guarantee of payment, you are responsible for the payment if your insurance does not pay as anticipated.
Our team is always happy to help and will answer any questions or concerns you may have. Please feel free to call us at for our Fort Apache office at 702-876-6337, or our Rancho office at 702-870-2555.
Fort Apache Office Provider Network
- Ameritas – PPO
- Anthem Blue Cross/ Blue Shield – PPO
- Assurant / DHA
- Cigna PPO
- Delta Dental – PPO
- EBMS
- Electrical Workers Local 357
- EMI Health
- Guardian
- Humana – PPO and Medicare
- Liberty – PPO (Choice and Select)
- Lincoln Financial
- LV Firefighters
- Metlife
- Premier Access
- Primecare
- Principal
- Renaissance
- The Standard
- UMR – PPO (Not UMC Plans)
- United Healthcare
- Zenith
Rancho Office Provider Network
- Aetna – PPO & Medicare (Rancho Only)
- Ameritas – PPO
- Anthem Blue Cross/ Blue Shield – PPO
- Assurant / DHA
- Cigna PPO
- Culinary (Rancho Only)
- Delta Dental – PPO
- EBMS
- Electrical Workers Local 357
- EMI Health
- Guardian
- Humana – PPO and Medicare
- Liberty – PPO (Choice and Select)
- Lincoln Financial
- LV Firefighters
- Metlife
- Premier Access
- Primecare
- Principal
- Renaissance
- Southpoint Benefits (Rancho Only)
- The Standard
- Sunlife Financial (Rancho Only)
- UMR – PPO (Not UMC Plans)
- United Concordia – PPO Non Military (Rancho Only)
- United Healthcare
- Zenith