Patient Forms
Welcome to Cody Dental Group
This page contains information for new and existing patients, including important forms, policies and documents that you may need to complete before your next appointment with us.
Important Forms for General Dentistry Patients
Patient Forms
Please review and complete these forms before your appointment:
Patient Forms – Printable
Pediatric Patient Forms
Please help us be prepared for your first appointment by completing the forms on our Cody Kids pediatric patient information page.
- Pediatric Medical Forms
- Pediatric Patient Information
- Pediatric Media Consent & Release
- Pediatric Patient Management Policies
- Notice of Privacy Practices
- Acknowledgment of Privacy Practices
Orthodontic Patient Form
Our orthodontist has an online questionnaire and medical history for patients to complete prior to their visit.
New Patients
New patients are always welcome at the Cody Dental Group. One advantage of having several dentists at a single location is that we are always able to accommodate new patients. We realize that when you choose a new dentist some questions will arise. Please feel free to call or email us with any questions or concerns.
It may not surprise you that our patients play a critical role in introducing their family and friends to our office and recommending our services. We are grateful for referrals of those in your circle of acquaintance and influence that would benefit from our care.
Your First Visit
We are glad you are here. On your first visit you will be greeted in our main reception area in a warm and friendly manner. At that time, we will collect necessary information about you and your medical history. If you have not had the opportunity to prepare these prior to your visit, we ask that you arrive 15 minutes before your appointment to allow time to complete these once you arrive.
One of the doctor’s assistants will then give you a mini-tour of the office and introduce you to the doctor and staff.
Generally, your first visit will include a comprehensive examination by the doctor with x-rays to follow, if needed. If you have current x-rays from visits to a previous dentist, please bring them along. A dental hygiene appointment can follow if requested, or may be scheduled for a later date.
It is important to us to establish a friendly and professional relationship with our patients.
We want to address your dental concerns and answer all your questions. We hope you enjoy your experience at the Cody Dental Group.
Office Policies
We take pride in providing you with the most thorough and comprehensive dental care possible. Our goal is to educate your family and to create enduring relationships in an environment of professionalism, technology and comfort. It is our desire to outline our office policies at the beginning of treatment to avoid confusion in the future.
Financial policy
We do ask that all new patients pay at the time of treatment. Upon payment from your insurance carrier we will either refund or credit your account as you choose. Any services billed must be paid upon receipt of your statement unless arrangements are made prior to treatment.
We will be happy to submit claims for those of you who have dental insurance. Your account balance, however, remains your responsibility. We submit insurance claims both manually and electronically depending on the insurance company’s ability to receive electronic data.
A monthly finance charge of 1.5% (18% annually) begins on unpaid balances 60 days after billing. Most insurance claims have been paid by 60 days. Should the account be turned over to a collection agency, you agree to pay all costs of collection including, but not limited to, court costs, agency fees and attorney fees.
Since people have various needs in fulfilling their financial obligations, we offer two options to pay for your dental care:
- We accept cash, personal check and MasterCard, Visa, Discover Card and American Express for payment in full at each visit.
- Third-party financial companies such as Chase Financial and Capital One; Easy flexible finance options: 12 months same as cash or a revolving line of credit with low monthly payments. Approval can be processed over the phone or in the office.
Appointments
As you know everyone’s time is valuable and last minute cancellations are extremely hard to fill. Therefore, we do ask that you respectfully give us 48 hours notice when you are unable to keep a reserved appointment. If 48 hours notice is not received a reasonable fee for time lost may be charged. Please review our Appointment pages for more information.
Privacy PolicyPrivacy Policy
Please download and read the Privacy Policy below:
Privacy Policy (PDF)
If you’re unable to read PDF files, you can download Adobe Reader for free from Adobe.
We look forward to seeing you. New patients are always invited, always welcome.