The New Patient forms are in PDF format, which can be read using Adobe Acrobat Reader.
If you do not have Adobe Acrobat Reader, get a free copy by clicking on the link below.
When you have Acrobat Reader, click on the links below to download the New Patient forms. Then print the forms, fill them out, and bring them with you on your first visit.
Dental insurance is
intended to cover some, but not all of the cost of your dental care. Most
plans include coinsurance provisions, a deductible, and certain other
expenses which must be paid by the patient at the time of services. Reimbursement
amounts are not, and never have been, a guideline for quality care.
We can file most insurance
claims for you. Please bring your insurance plan information with you
on your first visit. We will work with you to ensure that you receive
the maximum benefits to which you are entitled.
Payment is expected
at time of service. If you have insurance, you will be expected to make
an estimated payment for that portion not covered by your insurance plan.
For that portion of costs not covered by insurance, we offer several payment
options:
Cash or Personal
Check
Credit Card - We
accept MasterCard, Visa and Discover.
Accepts most insurances and Farm Vouchers.
Accepts KanCare for 18 and under. Accepts CareCredit.
If you have any questions
about your insurance plan or payment options, please call Our staff at (620) 663-5595 or e-mail us at HalsteadDentalClinic@gmail.com.