Patient Forms

Medical Forms and Information

PatientHistoryClipboard

To save you time at your initial visit, please print the forms listed below, complete them, and either:

• bring with you to your appointment

-or-

• scan the completed forms and email to info@pensacoladentalcenter.com

 

 

At your first visit every year, we will need your insurance card and photo ID for our records.

If you are coming in for a comprehensive exam and wish for us to accept assignment of dental insurance benefits (where your payment will be copays, deductibles, etc), please call us at 850-478-2998. Please have your insurance card and photo ID in hand when you call.
Your insurance information will be needed a few days prior to your appointment date so that we can verify eligibility and benefits.

If your first visit is a problem focused visit, you may bring your insurance information with you. We will be happy to file the paperwork to have your insurance benefits sent to you. Please note we DO NOT accept assignment of dental insurance benefits until you become a comprehensive care patient. As a result, we you are expected to pay IN FULL for your problem focused visit.

Patient Forms:

Patient General Information
Medical History