Helpful Patient Information
NEW PATIENT FORMS
We can’t wait to meet you – so let’s get started!
Prior to seeing each new orthodontic patient, we need to gather a little information. Here you will find the forms we need for your upcoming appointment. In order to save time at your appointment, please fill out our online formst! Alternatively, you may fill this out at our office; however, please arrive at least 15 minutes prior to your appointment to give yourself time to fill them out.
We value our patients’ privacy and would never sell or share your personal information. It is used solely for the purpose of providing you with excellent service, speeding up your visit and assisting with your insurance. See you soon!
Reminders for your first visit:
- There is no charge for your consultation appointment
- This appointment takes approximately one hour
- You can save time by filling out our new patient forms at home
- Please bring your dental insurance card
FINANCE & INSURANCE
Dr. Dougherty and the smile squad at Dougherty Orthodontics believes everyone deserves a beautiful, healthy smile and that is why we make every effort to offer payment plans that work with the financial needs of each of our patients. Every smile journey begins with a complimentary consultation. At this appointment we will collect digital x-rays, photo images and perform a complete examination. At the end of the visit, we will give you the cost of treatment and our treatment coordinator will be happy to discuss the payment options we offer to help make your treatment as budget-friendly as possible. Although the cost of treatment depends on the patient’s individual orthodontic issues, we want you to know that there are no hidden fees or extra fees that will be added at a later date.
- We offer flexible interest-free payment plans that are tailored to meet your budget. These consist of a down payment followed by monthly payments during treatment.
- If you choose our payment plan, monthly payments are made through electronic auto-debit from your debit or credit card. This is a convenient and efficient way to ensure that your payment is received on time, every time. This service is free for our patients.
- For your convenience, we accept payment by VISA, MASTERCARD, and DISCOVER.
- If full payment is made at the onset of treatment, we will offer a fee discount. (If you have insurance, we will offer a discount for payment of your portion of the fee that will not be covered by insurance.)
- We offer a Family Care Program that provides a fee reduction for each additional family member who begins treatment at Dougherty Orthodontics.
- The late fee for a missed payment is $25.00.
- In cases of serious delinquency, treatment will be discontinued, although we will make every effort to accommodate patients with temporary difficulties.
We accept most insurance plans. If you provide us with your insurance plan information before you come in for your consultation, we will call your insurance company to find out your specific benefits. The amount that your insurance covers will be deducted from the total treatment fee. As a service to you, we will take care of all the necessary insurance paperwork on your behalf.
WHAT TO EXPECT
Your step-by-step guide to your first visit:
WE CAN’T WAIT TO MAKE YOU Smile !
SCHEDULE YOUR NEW PATIENT COMPLIMENTARY CONSULTATION TODAY!
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