Patient Forms

At Tinker Tooth, we are a non-restrictive provider. This means we are a smaller, patient-oriented practice focused on high-quality patient care. We work with most insurances and are happy to maximize your insurance benefits; however, we do not have a direct contract with insurance companies. Your insurance benefits are determined by the type of plan chosen by you and/or your employer. As such, we have no say in the selection of your insurance company, we have no control over the terms of your contract, the method of reimbursement or the determination of your insurance benefits. The amount of coverage you will receive will depend on the quality of the plan purchased by your employer, not the fees of the doctor. Payment is due at the time of the service. As a courtesy to you, we will file the claim and submit to your insurance company for you. In order to do this, we MUST have the correct dental insurance information in order to submit a courtesy claim for you. The reimbursement is dictated by your contract with your dental insurance company.  

Please prepare for your first appointment by completing our new patient forms. Download the forms to your computer to complete at home, then bring them with you to your first appointment.

Insurance: 
Do we accept your PPO insurance: YES
Do we have contracted fees with your insurance: No
We are not influenced by the insurance companies and therefore can treat your child honestly and conservatively. 

• Medical History | PDF
• Financial Policy | PDF
• Appointment Cancellation Policy | PDF
• Privacy and HIPPA Notice | PDF

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