Before the First Visit | The First Visit | Insurance Change?
Before
the First Visit
Please discuss the positive aspects of dentistry with your child. One way
to convey good feelings to your child about dental visits is to remind them
that going to the dentist is a sign that they are “growing up”. You
can explain that Dr. Rubin will count their teeth, as well as take pictures
of his/her teeth. Please do not tell your child that the “dentist will
not hurt” as this may never have entered his/her mind. Instead, you may
wish to assure your child that Dr. Rubin will be gentle and friendly. Also,
please avoid using words needle, shot, pull, or any other words suggesting
unpleasantness. Expect your child to do well and
enjoy their visit to our
office and chances are he/she will do exactly that!
To Fill out forms online, please click the button below:
To print forms and fill them out,
please click a link below.
Please use blue or black ink when
filling the forms out!
Health History
Form
Responsible
Party Form
Privacy
Policies Form
Financial
and Appointment Policy
Authorization for Minor Child
To print the forms you will need Adobe Acrobat Reader. If you do not already have Adobe Acrobat, click the link to download it for free.
The First Visit
Our staff will review the health
history form with you at the first visit. You and your child will be
introduced to our dental team and invited to tour the office. Dr.
Rubin will perform a head and neck examination and then evaluate the
health of the teeth, gums and your child’s bite. Dental radiographs
are taken only as Dr. Rubin feels necessary. Additional services
will be scheduled for a later visit.
Insurance Change?
If you have a change in insurance, please complete
this form and email or fax back to us at
214-618-5201 no later than 48 hours prior to your child's
appointment. This will ensure adequate time to verify your new
benefits, otherwise you may be asked to pay for services up front.
click here to download Responsible Party Form
