10216 Dupont Circle Drive East , Fort Wayne, Indiana 46825

Appointments: (260) 489-0078

Appointments: (260) 489-0078

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    • Home
    • Facility
    • About Us
      • About Us
      • Long Term Relationships
      • Meet The Team
    • Services
      • Services
      • Technology
      • Dental FAQ
    • Smile Gallery
    • Payment Options
    • Contact Us
      • Contact Information
      • Patient Forms
    • Patient Portal Login
  • Home
  • Facility
  • About Us
    • About Us
    • Long Term Relationships
    • Meet The Team
  • Services
    • Services
    • Technology
    • Dental FAQ
  • Smile Gallery
  • Payment Options
  • Contact Us
    • Contact Information
    • Patient Forms
  • Patient Portal Login
SLC HI-Tech & Cosmetic Dentistry

Insurance:

We fill out the patient's claim forms and submit them at the time of service. (Although each insurance policy is different, generally insurance providers cover almost 100% of preventative care, 80% of restorative care, and 50% of major dental work.) We ask that the unpaid (co-pay) portion of the patient's charges be satisfied at the time of service.

Patient Forms

New Patient Information (pdf)Download
Medical History (pdf)Download
Hippa Notice of Privacy Practice (pdf)Download
Hippa Permission to Share (pdf)Download
Insurance Release and Financial Forms (pdf)Download

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