Patient Forms
For your convenience, we have supplied forms that can be filled on line. Click on the links below, complete the information and click the submit button. We will have them all ready for you when you make your first visit! We look forward to greeting you!
Online Patient Registration
Insurance and payment options
Dental treatment is an excellent investment in an individual's medical and psychological well being. Financial considerations should not be an obstacle to obtaining this important health service. Being sensitive to the fact that different people have different needs in fulfilling their financial obligations, we are providing the following payment options.
Flexible Monthly Payment Option
With our convenient payment plan administered by CareCredit, you can have the smile of your dreams today. CareCredit, the nation's leading patient payment program enables you to finance 100% of your dental care with NO money down, NO interest, no upfront costs, no annual fees, and no pre-payment penalties. So, begin your treatment TODAY!

CareCredit can be used by the entire family for ongoing treatment without having to reapply. CareCredit offers a comprehensive range of plan options, for treatment or procedure fees from $1 to over $25,000, and it only takes a few minutes to apply for CareCredit. To learn more about CareCredit, call 1-800-839-9078, or visit their web site at
www.CareCredit.com
Quality Dental Plan
Call our office at (515) 224-5999 to learn about the benefits of this amazing in-house dental plan. Learn more about the
Quality Dental Plan.
Payment in Full - Ask about our 5% courtesy discount for payment in full at the start of treatment for procedures over $1000.
We Accept Visa, MasterCard, American Express, and Discover.
Patients Who Have Dental Insurance - We welcome dental insurance. We will be happy to answer all of your questions and call your insurance provider to verify benefits.
As a courtesy to you, we are happy to bill your insurance company for you.