New Patient Forms, Map and Directions to our Novi Office


We welcome new patients to our office. We will require some vital information prior to your first visit. Please be prepared with your insurance provider's name, the subscriber ID, and some background information when calling to arrange your appointment. No insurance? No problem. Our office offers a discount on the standard rates. Please arrive a few minutes earlier before your first visit to complete the necessary paperwork and to familiarize yourself with our location, office and staff. You can also save time by printing out and completing the patient forms in advance of your appointment. We look forward to meeting you.


Mission Statement

Our practice is working together to realize a shared vision of uncompromising excellence in dentistry. To fulfill this mission, we are committed to:

  • Listening to those we are privileged to serve.
  • Earn the trust and respect of patients, profession and community.
  • Exceed your expectations.
  • Ensure a creative, challenging and compassionate professional environment.
  • Strive for continuous improvement at all levels.
     

Inital Consultation

Your initial oral examination includes a oral examination, charting, peridontal probing, diagnosis and treatment recommendations. We will also take x-rays, which include the panoramic x-ray for proper diagnosis of the anterior (front) and posterior (back) teeth as well as bite-wing x-ray series for proper diagnosis of proximal decay of posterior teeth.

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Summary of Notice of Privacy Practices

This describes how our office will protect your health information, your rights as a patient and our common practices in dealing with patient health information.

Uses and Disclosures of Health Information: We will use and disclose your health information in order to treat you or to assist other health care providers in treating you. We will also use and disclose your health information in order to obtain payment for our services or to allow insurance companies to process insurance claims for services rendered to you by us or other health care provideders. Finally, we may disclose your health information for certain limited operational activities such as quality assessment, licensing, accreditation and training of students.

Use and disclosures based on your authorization: Except as stated in more detail in the Notice of Privacy Practices, we will not use or disclose your health information without your written authorization.

Uses and disclosures NOT requiring your authorization: In the following circumstances, we may disclose your health information without your written authorization :

  • To family members or close friends who are involved in your health care
  • For certain limited research purposes
  • For purposes of public health and safety
  • To government agencies for purposes of their audits, investigation and other oversight activities
  • To government authorities to prevent child abuse and or domestic violence
  • To the FDA to report product defects or incidents
  • To law enforcement authorities to protect public safety or to assist in apprehending criminal offenders
  • When required by court orders, search warrants, subpoenas and as otherwise required by law

Patient Rights: As a patient you have the following rights:

  • To have access to and/or copy of your health information
  • To receive an accounting of certain disclosures we have made to your health information
  • To request restrictions as to how your health information is used and disclosed
  • To request that we communicate with you in confidence
  • To request that we amend your health information
  • To receive notice of our privacy practices

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Payment Options

Payment is expected at the time of service. Patients are responsible for balances due according to their insurance policies. Every effort will be made to keep your records up to date. Please notify our office of any insurance changes. Some major dental treatments are eligible for a payment plan and can be arranged in advance with the staff.



New Patient Form
Please print and fill out the new patient form so we can expedite your first visit:

In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.



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