Policies and Forms

All the nuts and bolts on one page!

Our office is PAPERLESS! If you have paper forms, please scan and email them. Thanks!

Office Policies

We have three policies that we feel are important to share with our patients. We strongly believe in our work and professional efforts. We therefore ask you to read this page thoroughly and then sign the downloadable form (link at right) to bring with you at the time of your first appointment, indicating that you understand these policies and agree to comply with them.

Commitment to Treatment Policy

We believe all treatment begun should be completed. Incomplete treatment leads to problems, complications, misunderstandings, and usually further disease. Therefore, if a plan is agreed upon and started, it needs to be completed.

Commitment to Appointment Policy

An appointment in our schedule is a bond of trust and we will be here to serve you and you will be present for treatment. Our office policy is firm in this regard and we will not tolerate frequent cancellations or constant short-notice changes. Your signature indicates that we must have mutual respect for each other's time.

Commitment to Financial Arrangement Policy

We believe we have the responsibility to use the best professional care, skill, and judgment in planning and delivering your dental treatment. Your payment will reimburse us for our services. By signing the form, you are indicating that after all fees are properly explained, you will agree to fulfill your financial commitment to our office promptly and completely.

Insurance Information

Understanding your insurance coverage can be quite challenging. Our goal is to assist you in maximizing your benefits. We care for patients from many different companies. Each company pays an insurance premium for specific coverage that fits the company budget. Each plan is slightly different in its covered services. We encourage you to become familiar with your policy exclusions, deductibles and required co-payments.

Our courtesy service to you includes:

  • Filing your insurance within 48 hours of your visit.
  • Electronically filing your insurance (when available) for short turnaround.
  • Researching your dental insurance plan to advise you of benefits available to you.
  • Re-filing your insurance a second time when necessary.
  • Following the American Dental Association guidelines for coding procedures and filing insurance.

Our expectations of you as the owner of the policy:

  • Payment of fees not covered by your insurance plan expected when the service is delivered unless prior financial arrangements have been made.
  • Understanding that the insurance policy belongs to you and we have no leverage to obtain payment from your insurance carrier.
  • Realizing that dental insurance policies restrict some services, use restricted fee schedules (called Usual and Customary Rates-UCR) and exclude some procedures based on prior conditions or length of time on the plan. All restrictions are based on the premium paid for insurance, not our fees or recommended treatment.
  • Taking responsibility for payment if the insurance company does not pay our office within 30 days.
  • Keeping our office informed of any changes in your insurance coverage or employment.

    Thank you for your cooperation with your dental insurance coverage.

New Patient Forms

In this section are forms that are very important. Before your first visit, please take the time necessary to accurately complete each form at the link below. We suggest that this be done when you're not rushed and can candidly reveal any past fears, disappointments or problems you may have experienced in dentistry. The more we know about you, the better we'll be able to serve you.

We love Dr. Nelson!

From the moment I walk in, I feel like they care.

They know who I am and call me by name. When I'm getting work done, everyone is friendly and personable. They remember things about my family and my life which puts me at ease because dental work stresses me out. Always friendly. Always helpful. I love this office.

REBECCA L.  //  November 2017

The Friendliest Office of Any Kind I've ever visited.

Like family......only nicer. Wonderful people. Excellent care. I look forward to my appointments. Dr. Nelson and his delightful staff make dentistry a pleasure. I don't think there is any room for improvement.

WAYNE W.  //  October 2017 

Copyright 2018, North Texas Dental Care

3900 Joe Ramsey Boulevard, Suite 7A Greenville, TX 75401

903-455-0360

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