Patient Information

Patient InformationWe strive to provide convenient and quality care to all our patients. If this is your first time, we invite you to contact us online to ask any additional questions you may have or request an appointment for a consultation. A member of our team will get back to you as soon as possible.
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New Patients
In order to give you the top-quality customized care you deserve, we would like to collect some information before the consultation. Please bring a list of medications you are taking, a referral slip for surgery, X-rays if necessary, and completed insurance forms. It is important that we have a thorough understanding of your health history and current conditions before advising you on oral surgery. We know you have a busy schedule, and paperwork can be a pain. That is why we have done our part to make it a little easier and made this new patient form available online. Patients who are under 18 must be accompanied by a parent or guardian to their first visit. If you have any questions regarding these forms or how to prepare for your first appointment, we are here to help. Call us at (763) 284-3159.

Financial Information for AppointmentPayments are due during the time the service is provided unless previous arrangements have been made. We accept most of the major insurance providers and most major credit cards. We also accept most people on state covered insurance. If you have any financial questions or concerns, please contact our Coon Rapids office by calling us at (763) 284-3159.
40% Cash Discount on all procedures for patients who don’t have dental insurance, excluding dental implants. 20% discount on dental implants for patients without dental insurance.
*You are responsible for all office fees no matter your insurance coverage.
Our practice will send you a monthly statement. If for any reason your statement does not reflect your payment within that time frame, please give us a call. Monthly payment plans must be set up prior to the actual procedure.
First VisitYour first visit will include a discussion with the doctor explaining your diagnosis as well as the procedure options. Some procedures can be done the same day as your first visit while the other, more serious treatments will need to be scheduled with an appointment.
Please provide the following to you first visit:
list of medications you are taking
referral slip for the surgery as well as necessary x-rays
completed insurance forms
Please complete the following forms before your visit:
HIPAA Acknowledgement
Condition of Acceptance for Treatment
Registration and Health History
*If you are under 18 you need a parent or guardian to accompany you for your first visit
Requirements before undergoing surgery:
A consultation and physical examination is mandatory
No eating or drinking 8 hours prior to surgery
An adult will need to drive you home after the surgery
Let office know if you have any medical conditions or are taking any medication BEFORE undergoing surgery
To schedule an appointment please call:
Coon Rapids office: (763) 284-3159:
Payment Methods – Check or Cash Accepted


Downloadable Forms:

Patient Registration Health Form

Condition of Acceptance for Treatment Form

Hippa Acknowledgement Form

Referral Form


First VisitYour first visit will include a discussion with the doctor explaining your diagnosis as well as the procedure options. Some procedures can be done the same day as your first visit while the other, more serious treatments will need to be scheduled with an appointment.
Please provide the following to you first visit:
list of medications you are taking
referral slip for the surgery as well as necessary x-rays
completed insurance forms
Please complete the following forms before your visit:
HIPAA Acknowledgement
Condition of Acceptance for Treatment
Registration and Health History
*If you are under 18 you need a parent or guardian to accompany you for your first visit
Requirements before undergoing surgery:
A consultation and physical examination is mandatory
No eating or drinking 8 hours prior to surgery
An adult will need to drive you home after the surgery
Let office know if you have any medical conditions or are taking any medication BEFORE undergoing surgery
To schedule an appointment please call:
Coon Rapids office: (763) 284-3159:
Payment Methods – Check or Cash Accepted

New Patients

Financial Information for Appointment

First Visit

Payment Methods – Check or Cash Accepted

Downloadable Forms:

First Visit

Payment Methods – Check or Cash Accepted

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