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Dental Emergencies

Appointments

Patients are seen by appointment only. We understand that every child may have unique oral conditions, and we will plan appointments to meet their specific needs. If you find that you are unable to keep a scheduled appointment, a 24-hour notice should be provided, so that we can provide another child in need of care with your appointment time.

What You Should Bring to Your First Visit

• Completed medical/dental history form
• Signed consent form
• Insurance information: card/claim form
• Information from referring doctor (including x-rays in available)
• Payment for expected copays
• Paperwork denoting guardianship (if necessary)

* A legal guardian must accompany all patients under 21 years of age.

Forms

• Registration (English)
• Registration (Spanish)
• Medical History (English)
• Medical History (Spanish)

Insurance and Billing Information

Our staff will be happy to assist you in filing your dental claims. To do this, you must bring your dental insurance information with you to each visit. All copays and fees for non-covered services are due on the date of treatment.

We only accept:

• Medicaid
• Hoosier Healthwise
• Children's Special Health Care
• Traditional Dental Insurance Plans
• Delta Dental Premier
• Delta PPO
• Delta Discount Plans