New Patient Forms

Save time, take care of the paperwork now.

Our New Patient Forms are available for you to print and complete them at your convenience, giving you time to carefully review our policies and procedures without having to do so at our office. Click on the "New Patient Form" buttons to print the forms and don’t forget to bring them to your first appointment.

Insurance Options

Patient Resources Our office is committed to helping you maximize your insurance benefits.

Because insurance policies vary, we can only estimate your coverage in good faith but cannot guarantee coverage due to the complexities of insurance contracts. Your estimated patient portion must be paid as per the contract agreement.

As a service to our patients, we will bill insurance companies for services. If you have any questions, our courteous staff is always available to answer them. If your insurance covers orthodontic treatment, you will receive the benefit of reduced personal costs. Many insurance policies have a lifetime orthodontic benefit that is distinct from regular dental insurance. Insurance policies vary, so we will review your insurance to determine the appropriate course of action.

Once treatment has started, we will file your claims. To help us with your insurance filing, please complete the insurance questions on our New Patient Registration Forms. Chesterfield Family Dentistry accepts most insurance plans. Please have your insurance information accessible when scheduling your first appointment - that way we can verify your insurance benefits and minimize your out-of-pocket expense! If your plan requires a dentist referral, please obtain one before scheduling your complimentary consultation to avoid treatment delays. Please bring your insurance card and information to your consultation appointment.