Patient Forms
Patient Information Form: Click Here
Medical History Form: Click Here
Financial Policy Agreement: Click Here
Scheduling Policy
We reserve your appointment time exclusively for you and only book one patient at a time, so that you receive our undivided attention during your scheduled appointment. Therefore, we ask that you give us at least two business days’ notice if you are unable to make your appointment. This allows us to offer the appointment time to another patient. A $50 to $100 fee, depending on the amount of time that was reserved for you, will be applied to your account for rescheduling, cancelling, or failing to show up for your appointment without 2 business days’ notice.
Same-Day Emergencies
When you experience a dental emergency, you need to see a dentist right away. We set aside time in our schedule each day for patients with unexpected emergencies, so that we can help alleviate your pain quickly and efficiently.
Our Approach to Anxiety Free Dental Visits
We are committed to making your dental visit anxiety and stress free. If you are feeling anxious about your dental visit, please feel free to call our office and we will discuss your treatment plan and exactly what we will be doing at your upcoming appointment. For those patients that are still feeling anxious, we also offer nitrous oxide sedation during your dental visit.
Nitrous Oxide Sedation
Experience stress free dentistry here at 5th Avenue Dental. Nitrous oxide is used for patients that experience anxiety when visiting the dentist. It is a non-allergenic, non-irritating gas that has no color or smell. By simply breathing the nitrous oxide you will feel more relaxed and less discomfort. It is one of the safest forms of sedation. Patients begin to feel the effects almost immediately and the effects wear off within 3-5 minutes, allowing patients to be able to drive themselves home safely after the appointment.
Financial Policy
Our primary goal is not to allow the cost of treatment to prevent you from benefiting from the quality care you need or desire. In our office, we strive to maximize your insurance benefits and make any remaining balance easily affordable.
For your convenience we accept most major credit cards (Mastercard, Visa, Discover, American Express) as well as cash and check. In addition, we offer CareCredit, a patient payment program offering a full range of No Interest and Extended Payment Plans for treatment fees from $1 and up.
We deliver the finest care at the most reasonable cost to our patients, therefore payment is due at the time service is rendered with a 5% discount unless other arrangements have been made in advance. If you have questions regarding your account, please contact us at 717-272-9552. Many times, a simple telephone call will clear any misunderstandings.
Insurance Patients:
It’s important to remember that your insurance coverage is a contract between your employer and your insurance company. Benefits and coverage vary significantly from plan to plan depending on what your employer has agreed to with the insurer. Please keep in mind that insurance is not designed to provide 100% benefit, but rather is meant to assist in the cost of dental care. To avoid surprises on your bill, it is important to understand what your insurance will cover, and what you will need to cover in some other way. Dental benefits should not be confused with the dental services you need, which are determined by you and the doctors of 5th Avenue Dental.
As a courtesy to our patients, we are happy to submit your claims for services. In order for us to do this, you must provide us with accurate and up-to-date insurance information. We will verify your coverage and plan before your appointment. With this, we will make every effort to be as accurate as possible when estimating your co-payment and deductible, which is due at the time of service; however, your insurance may not cover as much as we estimate. Any amount not paid by insurance is your responsibility.
We will wait 45 days for insurance claims to be paid. After 45 days, if payment has not been made, you will be asked to pay the balance and seek reimbursement from your insurance company.