New Patient Information
Your First Visit at Kind by Khine Dental
Your initial appointment will consist of a review of your medical and dental history, a full mouth examination, an oral cancer screening, a complete series of x-rays and necessary photographs. A cleaning (prophylaxis) will also be completed if there are no periodontal (gum) problems diagnosed. For more complex treatment plans, at a second visit consultation, We will review with you the diagnostic findings, treatment options, priorities, and convenient financial options.
Please assist us by providing the following information at the time of your consultation:
- Any current x-rays if available
- A list of your current medical prescriptions
- Any need for antibiotic prior to dental treatment
If there are any questions regarding pre-medication, please contact our office. This will also be covered when we review your medical history.
If you have dental insurance, bring the necessary completed forms. This will save time and allow us to help you process any claims.
Privacy Policy, HIPAA Forms and New Patient Forms
As of April 14, 2003 the Health Insurance Portability and Accountability Act (HIPAA) went into effect. Our office has gone to great lengths to ensure the confidentiality and privacy of every patient. We are compliant with the electronic transmission of dental claims, including firewalls, software certification and requirements and coding. A copy of our Notice of Privacy Practices is available to all patients and is posted in our office for your review. A Written Acknowledgment will be given to every patient to sign after review of our policies. You have the right to refuse to sign this form, however, we will not be able to transmit insurance claims on your behalf. Please feel free to ask any staff member any questions regarding HIPAA.
This form, Notice of Privacy Practices, presents the information that federal law requires us to give our patients regarding our privacy practices.
