Patient Information

Fort Wayne Dental Office Policies

We appreciate your selection of our office to serve your dental health needs. Our goal is to provide the very best possible dental care for our patients so that each of you may achieve optimal dental health.

Our entire staff operates as a team and we take great pride in each staff members training and capabilities.

Please review the following information to become more familiar with our office policies.


Patients are seen by appointment only. Please call in advance so we may reserve a time for you. We make every effort to be on time for our patients, and ask that you extend the same courtesy to us. If you cannot keep an appointment, please notify us immediately. If possible please give us 24 hours notice. This courtesy on your part makes it possible for us to give your appointment to another patient.

If you are attending an initial appointment, you may download our Patient Information Form, complete at home and bring it with you to your first visit.

Emergency care

We will see emergency patients as soon as possible. Emergency patients are worked into the daily schedule. Our voicemail system is available for messages during lunch, after hours and during weekends.

Our philosophy

Our office philosophy is one of preventive dental care. Preventive cleaning appointments are scheduled in advance to ensure that our patients receive the best preventative care possible.


Since exposure to tobacco smoke is detrimental to your health, we ask you to refrain from smoking while in our office.


Fees and payment policy

In an effort to keep dental costs down while maintaining a high level of professional care we have established the following payment plans for the use of our patients.

Fees may be paid as follows:

1 Prepayment, or payment at time of treatment with a 5% discount

2 Payment of balance in full upon receipt of statement

3 Use of your CareCredit, DISCOVER, MASTERCARD, or VISA credit cards

Extended payments are available in special circumstances. Accounts outstanding more than 60 days from treatment date will bear interest at 1.5% per month or 18% annually.

All major treatment and treatment involving a laboratory procedure will require an appropriate down payment. Our senior citizens (62 and over) will receive 10% discount for payment at time of treatment.


If you have insurance we will help you to determine the coverage you have available. We ask that you assign your insurance benefit to us. The balance will be arranged for you to pay as listed above.

Professional care is provided to you, our patients and not to an insurance company. Thus, the insurance company is responsible to the patient and the patient is responsible to the doctor. We will help in every way we can in filing your claim and handling insurance questions from our office on your behalf.


VISA or Mastercard

All payments can be spread out up to 6 months interest free

We are committed to providing the best dental service in Fort Wayne, and we love to open our doors to new faces and new smiles every day. If you’re thinking about scheduling your first appointment at our offices in Fort Wayne, or have already done so, we have a few forms we need so that we can begin providing you with the highest quality care possible.

Our New Patient Forms

We appreciate you trusting us for your dental care and oral hygiene services. Before your visit, our office requires a few forms for our records.

New Patient Information Forms

Dental Treatment Consent Form

Notice of Privacy Practices

Office Policy

Please fill these forms out at your convenience so that we can get right to work meeting your every need. If you are not able to fill out these forms prior to your appointment, we do have copies available in our office that you can fill out upon arrival.

Additionally, we want all our clients and potential clients to know that we offer financing through Care Credit. Call our office today to learn more.

Contact us with any questions you may have: