Patient Information

First Visit

Welcome to Serenity Valley Family Dental. We’re very happy to have you join our family dentistry practice and promise to make you as comfortable as possible while you’re with us.

Please arrive 10-15 minutes before your first appointment and bring the following to the receptionist at our front desk: (if you cannot download these forms, please call our office and we can mail them to you prior to your appointment)

1. Completed  new patient forms
2. Completed HIPAA authorization (link)
3. Insurance card, if applicable
4. Photo ID (driver’s license, student ID)
5. Any dental appliances you use (retainer, mouthguard, splint)

If you have any medical conditions that require you to take medication before dental work, please follow your physician’s instructions. We also ask you to include that information on your health forms and inform your hygienist about your medication upon arrival.

After checking in, we invite you to relax in our lobby until your hygienist is ready for you. We recognize your time is valuable and we work very hard to keep our appointments on time so you can get in and out and on with your day. We do offer a complimentary beverage bar and wireless internet connection in our lobby for those guests who wish to use mobile devices while waiting. (We’re all about keeping your teeth healthy so it only makes sense that we support people’s “Candy Crushing” habits.)

Notice of Privacy Practices

Pediatric First Visit

You are encouraged to introduce your little ones to our dental office as young as two years old. We want to take the fear out of a new environment and healthcare provider by giving them a tour of our office, letting them ride up and down in the dental chair, giving them their very own toothbrush and giving them a chance to explore a bit on their terms. If they don’t want to, we won’t even ask them to open their mouths. If they are comfortable, we’ll ask them if we can count their teeth. Together, based on your child’s comfort level, we’ll ease into a preventive dental checkup on their next visit. Our goal will be to begin the standard twice yearly preventive care visits by age four or five.

Of course, if your child has any mouth pain, has recurring mouth sores such as cold sores or canker sores, is a thumb sucker or has any oral health issues, we’d like to see them as soon as possible regardless of their age. Oral health has a dramatic effect on overall health, so please don’t wait if you see or suspect any oral health issues.

In preparation for your child’s first appointment, please download, complete this form and bring it to the appointment.

Financial Options & Insurance

Insurance

Serenity Valley Family Dentistry accepts most dental insurance plans, including the following:

• Delta Dental / Premier® (Preferred Provider)
• Cigna/Tricare
• Aetna
• HealthPartners
• Humana
• Metlife
• Premier Dental Group
• United Health Care
• VA Dental Insurance Program (VADIP)

If you do not see your plan or insurance carrier here, please call our office because we do occasionally add new plans. You are also welcome to contact your insurance provider to ask if we are in their network.

Most insurance companies only pay a portion of the fees incurred. We require your portion to be paid at the time the procedure(s) take place (unless financial arrangements have been made). We try to get an estimate from your insurance company on your portion, but they ultimately decide if and at what percentage treatment is covered at, at the time the claim is filed. You are responsible for all charges not paid by insurance. As a courtesy to you, we will bill your insurance carrier for you.

You are responsible for paying any deductible or co-pay fees for each visit. We accept cash, personal checks and major credit cards for these payments at the time of service.

Serenity Benefits Discount Program

The Serenity Benefits discount program provides 15% savings on dental services. This program affords you significant savings on personalized, full-service dental care for your whole family without the hassles and limitations of traditional insurance.

• Save 15% on ALL preventative, restorative and cosmetic services
• No waiting period
• One low annual fee ($49 for individuals, $99 for families)
• Enrollment is quick and easy

Ask our receptionist for enrollment details.

Care Credit

For major dental treatments, we do partner with CareCredit financing options with flexible monthly payment plans. Please ask our receptionist for more information. Note, 15% discount can not be used if using Care Credit.

Payment Options

If you are in need of short-term financing for services, monthly payment plans are available. You must have a major credit card and payment options are subject to approval on a per-case basis. Please ask our receptionist for more information.

Patient Portal

Make payments easily online.