New Patients
Patient Forms
First Visit
Your initial appointment will consist of an examination and assessment of your case. Your medical and dental histories, and information provided by your dentist will be reviewed. Dr. Mansour will discuss your diagnosis and treatment options, and outline a solution that best fits your individual needs and desires. Any questions you have will be addressed at this time including:
- The date(s) and length of your treatment appointment(s)
- Prescriptions, if recommended
- Cost, including estimate of insurance benefits so that you are aware of your financial obligation ahead of time
- Follow up treatment with your general dentist, if required
- Sedation options for our patients who have anxiety with dental treatment
Please assist us by providing the flowing information at the time of your consultation:
- Your referral slip and any recent X-rays if applicable
- A list of medications you are presently taking
- If you have dental insurance, bring the necessary information. This will save time and allow us to help you process any claims
IMPORTANT: Patients under 18 must be accompanied by a parent or guardian at the consultation visit
Scheduling
We are committed to treating every patient with compassion and patience. Our goal is to schedule treatment appointments so that Dr. Mansour devotes his attention to only one patient at a time. We will schedule your appointment as promptly as possible. If you have a severe infection or uncontrollable pain, we will do our very best to accommodate you the same day. Because we attempt to be efficient and courteous, we ask that you provide us with at least 48 hours notice if you must reschedule your appointment so that we may accommodate other patients. Broken appointments or changes with insufficient notice will result in an additional fee.
Sedation Options
Our goal is to create a safe and comfortable dental experience for our patients. For those who have fear or anxiety, Dr. Mansour is licensed to provide nitrous oxide (laughing gas) and oral conscious sedation for relaxation. If desired, IV sedation can be provided by an anesthesiologist. We use well established and proven sedation techniques and state of the art medical monitoring equipment. The sedation experience is customized to the patient’s individual emotional and physical needs. We encourage you to contact our office to learn more about the availability of these treatment options.
Financial Policy
Payment is due at the time of service. We accept cash (5% discount if paid in full), debit cards and major credit cards.
Financing may be available through CareCredit.
An estimate of the amount covered by your insurance company will be provided prior to your treatment,
based on the information provided to us. The estimate is never a guarantee of benefits or the amount that will be paid.
As a courtesy to you, we will process and track insurance claims on your behalf. This does not transfer the responsibility of your
financial obligation to the insurance company. The majority of insurance companies respond to claims within two to six weeks.
You are responsible for the fees charged by our office, regardless of what your insurance coverage may be.
If the amount paid by the insurance company is less than or greater than the estimate, you will be billed the difference or issued a refund.