New Dentist Patient Forms
Below are our new dentist patient forms in PDF format. Please complete the online registration forms before your first visit. If you are unable to complete the forms online, you may download them, print them, and fax or mail them to the office prior to your first appointment:
New Dentist Patients
On your first visit we will review your medical history, update necessary X-rays and complete a comprehensive dental and periodontal exam. This includes an oral cancer screening and a head and neck exam. This visit will include a consultation explaining your diagnosis and treatment options. However, a complex medical history or treatment plan will require an evaluation and subsequent appointments. We will then schedule an appointment with a hygienist for your periodontal care, or "cleanings". We look forward to meeting you - call us today!
IMPORTANT: A parent or guardian must accompany all patients under 18 at the consultation visit.
Please provide the following information at the time of your consultation:
- Any recent X-rays. In most cases we can obtain these via email from your previous dentist. Often, the quality of X-rays we receive from other doctors is not diagnostic. In that case, we may need to update your X-rays.
- A list of medications you are currently taking.
- If you have dental insurance, your insurance card. This will save time and help you process any claims.
Also, please alert the office if you have a medical condition that may be of concern such as diabetes, high blood pressure, artificial heart valves and joints, etc., or if you are taking any medication (i.e. heart medications, aspirin, anticoagulant therapy, etc.) or require medication prior to dental cleanings (i.e. antibiotics, for pre-med.)
Scheduling your Dental Appointment
Austin City Dental is open Monday through Thursday 7:30 a.m. to 4 p.m., and Friday by appointment only. We will schedule your appointment as promptly as possible. If you have pain or an emergency situation, every attempt will be made to see you that day.
We try our best to stay on schedule to minimize your waiting time. Since Dr. Cook provides many types of dental services, various circumstances may lengthen the time allocated for a procedure.
Emergency cases can also arise and cause delays as it is our policy to see patients with emergencies the day you call. We will do everything possible to see you promptly. We appreciate your understanding and patience.
Dental Insurance and Billing
Dr. Cook and staff are proud to be a team whose primary mission is to deliver the finest and most comprehensive dental services available today. We make every effort to provide you with the finest care and the most convenient financial options.
We will work with you to maximize your insurance reimbursement for covered procedures. Please bring your insurance information with you to your consultation so that we can expedite reimbursement. We accept all traditional or indemnity insurance plans.
For Emergency or Single Visits
Payment is due in full at the time of service. For your convenience we accept cash, checks, money orders, and credit cards (MasterCard, Visa, Discover, and American Express).
For Multiple Visits and Regular Dental Patients
Option 1 - Full payment at time of service. We provide a 5% courtesy fee reduction for payment before treatment is rendered. Selection of this option gives you the maximum savings on the cost of your treatment plan because we pass on savings for billing expenses in the form of a 5% discount. Your Treatment Coordinator will provide you with specific details.
Option 2 - Open account payment plan. Fees are divided into 2 or 3 equal payments for those individuals desiring a more flexible payment plan. This plan allows for three equal payments to be paid out over a period of three months. The first payment of one-third is due at the time of treatment, the second payment is due one month after treatment, and the third and final payment is due two months after treatment. This option is available to patients with accounts in good standing and a history of on-time payments.
Option 3 - Extended payment plan. For those who would prefer an extended payment plan, outside financing is available. For your convenience, payments may be made with cash, personal check, and bank draft, MasterCard, Visa, Discover, and American Express. If you have any concerns or questions, please speak with our staff.