Patient Forms

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Patient Forms

Accepting New Patients At southeast dental

What to expect from your first visit

Your initial appointment will consist of a consultation that will explain your diagnosis and treatment options. We typically will perform a dental cleaning (prophylaxis) as well. However, a complex medical history or treatment plan will require an evaluation and a second appointment to provide treatment on a separate day. For assistance, please call our Southeast Dental in Dothan, AL Phone Number (650) 733 – 6825  or (650) 7-Dental. Please assist us by providing the following information at the time of your consultation: 

  • X-rays (if applicable)
  • A list of your current medications
  • If you have medical or dental insurance, bring the necessary completed forms. This will save time and allow us to help you process any claims.

IMPORTANT:

  • A parent or guardian must accompany all patients under the age of 18 at the consultation visit.
  • Please alert the office if you have a medical condition that may be of concern prior to surgery (i.e., diabetes, high blood pressure, artificial heart valves and joints, rheumatic fever, etc.)
  • You will need to let us know if you are on any medications (i.e., heart medications, aspirin, anticoagulant therapy, etc.)

X-RAYS

If you have x-rays from a previous dentist or physician, you may request that they forward them to our office. If there is not enough time, please pick them up and bring them to our office. If additional films are necessary, they can be taken at our facility.

Financing Info

Payment Policy

Therefore We deliver the finest care at the most reasonable cost to our patients. Therefore payment is due at the time service is rendered, unless other arrangements have been made in advance.

Please remember you are fully responsible for all fees charged by this office regardless of your insurance coverage.

Dental Payment Options

For your convenience, we accept cash, check, American Express, Discover, MasterCard and Visa.

We also accept CareCredit and ClearGage.

Billing Information

We will send you a monthly statement. Most insurance companies will respond within four to six weeks. Please call our office if your statement does not reflect your insurance payment within that time frame: Southeast Dental Office in Dothan AL.

 Phone Number (650) 733-6825 or (650) 7-dental.

Any remaining balance after your insurance has paid is your responsibility. Your prompt remittance is appreciated. We can make arrangements for a monthly payment plan, but this must be accomplished prior to the actual procedure. 

NEW Patient Form

Insurances Accepted

HAVE QUESTIONS?

Let our amazing staff help you choose the right option for you and your family.