Please CLICK HERE For instructions to convert to Electronic Billing

Resources

Our library: No card, no overdue fees.
Just a handy list of links to download the document you need right now.

Attending Physician Statement

Did you injure your tooth? If so, an Attending Physicians Statement Form may be required. Our carriers require this form because we need to know the integrity of the mouth prior to the injury.

DOWNLOAD FORM

HIPAA Release Form

For anyone who is 18 and older, this Personal Health Information Release Form needs to be completed in the event that you would like us to speak to any other party outside of yourself (i.e. parent/guardian).

DOWNLOAD FORM

Insurance Verification Forms

Over 18      Under 18

Need to upload documents to an existing claim? 

Existing Claim Update

Do you have an existing claim on file and you would like to submit documents affiliated to that claim? If so, you have the ability to upload those documents right here. No need to fax or send in the mail. Our online document upload makes the process easy and efficient for you to submit claim documents to us, at any time of day.

Upload Claim Documents