Patient Forms

We welcome new patients to our practice! If you are new to the area or just looking for a new dentist, we want you to be part of our family. For your convenience, we now provide an Online Patient Questionnaire. Please click the link below and complete the online patient form. It will enabling our clinical and administrative staff to prepare for your first visit, and make check-in for your appointment quicker and easier.

New Patient Paperwork

Adult Preventative Plan

(15 years and up)

› 2 Preventative Cleanings › 2 Doctor Examinations › 2 Fluoride Treatments › 1 Set of X-Rays

STANDARD INVESTMENT:

$644

WITH SAVINGS PLAN:

$483
YOU SAVE 25%!

Perio Maintenance Plan

› Up to 4 Perio Maintenance Visits › 2 Doctor Examinations › 2 Fluoride Treatments › 1 Set of X-Rays

STANDARD INVESTMENT:

$1,132

WITH SAVINGS PLAN:

$849
YOU SAVE 25%!

Child Preventative Plan

(14 years and under)

› 2 Preventative Cleanings › 2 Doctor Examinations › 2 Fluoride Treatments › 1 Set of X-Rays

STANDARD INVESTMENT:

$580

WITH SAVINGS PLAN:

$435
YOU SAVE 20%!

Implant Maintenance Plan

› 2 Implant Cleaning Visits › 2 Doctor Examinations › 2 Antibacterial Varnishes › 1 Set of X-Rays

STANDARD INVESTMENT:

$874

WITH SAVINGS PLAN:

$656
YOU SAVE 25%!

Financial Options

Here at Orchard Meadows we are happy to provide our patients with various options to facilitate your dental care.

Credit Card:

Debit Card

Checks

Cash

We also offer Third Party financing through CareCredit® OR LendingCLUB® With the help of CareCredit® OR LendingCLUB® qualifying patients are able to better finance and make monthly payments. Click on the below links to learn more and apply online!

Insurance Information

We will file all insurance claims for you, and we are Preferred Providers with Delta Dental. However, we ask the you realize that we don’t work for an insurance company. Rather we work 100% for our patients. We feel that insurance can be a great benefit for many patients and want you to know we will do
everything in our power to ensure you get every benefit allotted in your insurance contract. However, the treatment we recommend and your fees we charge will always be based on your individual needs, not your insurance coverage. If you have any further questions about your insurance, please give us a call at (605) 737-3150.