Patient Forms and Information

New Patients 

At Caring Smile Family Dentistry, we are gladly accepting new patients. We strive to help all of our patients schedule appointments as effortlessly as possible. Please do not hesitate to contact us with any questions you may have about the practice or about scheduling your first appointment. 

​Patient Forms 

If you are a new patient to our office, the attached files contain our new patient forms that will need to be filled out before your appointment time.  Printing them, filling them out and bringing them with you will allow us to attend to your needs in a timely manner. If you prefer to complete the forms upon arriving to the office, please arrive 15 minutes prior to your scheduled appointment time.

Patient Information Form

Medical History Form

HIPPA Acknowledgement Form

CSFD Privacy Practices

Practice Policies


This web site uses files in Adobe Acrobat Portable Document Format  (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.


Payment Options

For your convenience, we accept cash, personal checks, money orders, Visa, Master Card, Discover, and Care Credit. Payment is expected at the time services are performed. When more extensive dental care is necessary, financial arrangements can be made with our office.  



Insurance

As a service to our patients, our practice accepts most dental insurance programs, including non-managed care, indemnity (traditional) and PPO out-of-network.  We are not part of any managed care network.  Our accounting staff will prepare all the necessary forms for your dental benefits. However, we remind you that your specific policy is an agreement between you and your insurance company. Please keep in mind that you are responsible for your total obligation should your insurance benefits result in less coverage than anticipated. Our staff will gladly submit a pre-treatment estimate to your insurance company so that you will know what your benefits will be.

The fees charged for services rendered to those who are insured are the usual and customary fees charged to all our patients for similar services. Your policy may base its allowances on a fixed fee schedule, which may or may not coincide with our usual fees. You should be aware that different insurance companies vary greatly in the types of coverage available. Also, some companies take care of claims promptly while others delay payment for several months.

Contact Us

We encourage you to contact us with any questions or to schedule an appointment. Please call our office at 919-845-7778, email us caringsmile@outlook.com, or use the quick contact form below.
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