New Patient Forms

Click on the form that you want to go to that New Patient form.


Pediatric Patient Form    Orthodontic Patient Form

Office Policies

Girl Smiling

OFFICE HOURS

Our office is available Monday-Thursday from 7am-4pm with select Fridays and Saturdays. We may be reached at 719-260-1600. Our doctors are available after hours 24 hours per day/365 days per year if you call the following emergency line 719-425-9833. This goes to the cellphone of the doctors and will be returned ASAP.

CAN I ACCOMPANY MY CHILD DURING HIS/HER DENTAL APPOINTMENT?

Yes, we invite you to join us for their examination or appointment. Keep in mind that some children behave better without their guardian present, but we allow you to make that decision.

URGENT NEEDS

Our goal is to be able to provide urgent dental care within one week of an acute problem. Please call us if you suspect a problem immediately.

APPOINTMENTS

Briargate Pediatric Dentistry and Orthodontics is committed to providing quality care to our patients. To ensure timely continued care, we encourage patients to schedule appointments in advance of recare or orthodontic adjustment dates. When calling for an appointment, please provide the child’s name, your telephone number, chief complaint/reason for visit, as well as any updated contact or insurance information. While we strive to schedule appointments appropriately, emergencies can and do occur. We strive to give all of our patients the time that they require. For this reason, we kindly request your patience and understanding should a delay or rescheduling become necessary.

CANCELLING AN APPOINTMENT

In order to be respectful please be courteous and call Briargate Pediatric Dentistry and Orthodontics promptly if you are unable to attend an appointment. This time will be reallocated to someone who is in need of an appointment. This is how we can best serve the needs of our patients! If it is necessary to cancel your scheduled appointment we require that you call one (1) working day in advance. Appointments are in high demand, and your early cancellation will give another person the ability to have access to timely dental care.

There is a cancellation fee for an appointment with less than 24 hour notice.

NO SHOW POLICY

A “no show” is someone who misses an appointment without canceling it within one (1) business day in advance. No-shows inconvenience those individuals who need access to dental and orthodontic care in a timely manner. A failure to present at the time of a scheduled appointment will be recorded in your medical chart as a “no show”. An administrative fee will be charged for the following no-shows:

MEDICAL RECORDS

Per HIPAA guidelines, copies of medical records must be requested in writing. To ensure your privacy, a form for release of medical information must be completed prior to receipt of these materials. The law allows Medical Offices 30 days to complete requests for records. However, we put forth every effort to respond to these requests in a timely manner.

ORTHODONTIC FINANCIAL CONTRACTS

Truth and Lending Contract: Federal law requires a financial contract between Briargate Pediatric Dentistry and Orthodontics and the party responsible for payment of treatment fees. Hereafter, “responsible party” refers to the parent/guardian of a minor patient or the adult patient consenting to and financially responsible for orthodontic treatment. The Truth and Lending contract applies to Phase I, Phase II, Limited and Comprehensive Orthodontic treatment. Our policy is to create only one Truth and Leaning Contract and to allow for only one signee. Under no circumstances will treatment fees be split between two responsible parties. This includes patients who are minors of parents who are separated/divorced. A single ledger for the treatment fee account will be kept. We will not become involved in personal situations between separated/divorced persons. Divisions of costs between parents, spouses or others is a private matter and will not be managed by our doctors or staff.

PAYMENTS

Briargate Pediatric Dentistry accepts cash, personal checks, MasterCard, Discover, Visa and American Express. Checks can be made out to Briargate Pediatric Dentistry and Orthodontics. It is the policy of Briargate Pediatric Dentistry to make all reasonable attempts to collect outstanding balances’ should they accrue, including, convenient payment arrangements.

INSURANCE

Briargate Pediatric Dentistry and Orthodontics accepts most dental insurances. If you have specific questions regarding your insurance, please call us! It is patient responsibility to inform our office of any changes in insurance coverage. Failure to do so could cause delay or denial of insurance payment. Patients are responsible for co-pays at time of service. If applicable, you will be billed for services not covered by your insurance (as stated in your insurance contract).

For more information, call us at 719-260-1600

Back to Top