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Forms & Policies
Our office staff will help you to schedule appointments, complete necessary paperwork, and answer any billing questions that you may have. Please complete the forms below and have them ready for your appointment.

Patient Registration & Health History Form
Financial Agreement & Authorization for Treatment Form
Privacy Practices Acknowledgement

Patient Appointments
Patients are seen by appointment only. We make every effort to be on time for our patients, and we ask the same courtesy from your family. If you cannot keep an appointment, please notify us immediately, giving a minimum of 48 hour notice to avoid any missed appointment fees. We realize that unexpected illnesses and emergencies may occur, but we ask for your assistance in this regard.

Our office strives to schedule appointments at your convenience and when time is available.

Insurance & Patient Co-payments
If you have insurance we will help you determine the coverage you have available. In order to best assist you, it is important that you submit your dental and/or medical insurance information to us with your child's New Patient Paperwork a minimum of two business days prior to your scheduled appointment. This allows us time to contact your insurance company and obtain a breakdown of the benefits your employer or you have purchased from the company. In addition, you will want to bring a dental benefit book that your carrier should be able to provide. Our business team will be happy to help you understand your policy.

Should your child be diagnosed with treatment services, we will be able to provide you with a detailed plan which will give you an estimate of how much your insurance company may pay for each procedure, as well as the portion you will be expected to pay at the time of service.

Professional care is provided to your child, and not to an insurance company. The insurance company is responsible only to the patient as a benefit from the employer or individual plan purchase, and the patient is responsible to the doctor.

Financial Policy
In an effort to reduce the cost to you, the patient, while maintaining the highest level of professional care, we have established the financial policy as follows:

• Payment of any account balance is due in full within 20 days of statement date.
• We gladly accept Visa, Discover, American Express, or MasterCard payments.
• Payment plans are available through www.CareCredit.com.

Appointments & Consultations
We are happy to schedule a second-opinion consultation with Dr. Clara Brannan to discuss treatment diagnosed for your child. It is important to us that our families are committed fully to a recommended course of treatment, and we make every effort to provide all available information on the types of treatment completed at South Hill Children's Dentistry, as well as options to make appointments comfortable.













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Clara Brannan - South Hill Children's Dentistry | www.southhillchildrensdentistry.com | (253) 848-1022
11102 Sunrise Blvd E., Suite 108, Puyallup, WA 98374