New Patient Information
Your First Visit
Are you getting ready for your first visit at one of the five convenient Danville Dental Associates locations? We’re looking forward to seeing you and your family in our office! If you haven’t scheduled the appointment yet, we encourage you to give us a call. One of our knowledgeable team members will schedule your hygiene appointment. Before you arrive, we invite you to complete your new patient forms from the comfort of home. Otherwise, you’ll be able to complete these forms at computer kiosks in our waiting area. After you’re all checked in, one of our skilled hygienists will carefully capture x-rays, clean your smile, discuss your at-home hygiene routine, and screen for oral cancer. The dentist will then examine your smile and x-rays, and talk to you about any urgent care needs you may have and make a plan to optimize your oral health.
We ask that all new patients please complete the new patient forms, linked below, prior to their appointment. If you are unable to print them, please contact our office, and we would be more than happy to mail them to you. This helps the efficiency of our office, and gives us a more complete picture of the state of your dental health.
Patient Registration Medical History Patient Consent Form Financial Agreement Notice of Privacy Practices HIPAA Disclosure Form Patient Survey Danville Dental Discount Program Terms Sleep Screening Questionnaire
We Accept the Following Payment Options
- Check (There is a $25 fee on all checks returned by the bank to us for insufficient funds).
- Credit Cards, including Visa, MasterCard, Discover, and American Express.
Cash Payment Discounts
If the balance on your account is zero prior to entering the charges for your current date’s services:
- A 10% discount will be given when paying the full balance with cash or check.
- A 5 % discount will be given when paying the full balance with credit card.
- No discount is given when paying with CareCredit.
Financial Agreement Policy
If you have dental insurance, make sure to bring your insurance card with you on your first visit. If at some point during your care at Danville Dental Associates the status of your insurance coverage changes or you change insurance carriers, we ask that you notify our office so we may update your records.
As a courtesy to our patients, we file all insurance claims free of charge. Our office files claims electronically with your insurance provider to expedite reimbursement. We are currently participating providers under Anthem, Delta Dental, MetLife, the Cigna Discount Program and the Virginia Medicaid system for children 18 years of age and under. We do file claims for all insurance carriers.
Based on your dental care plan, we will estimate your coverage, so that you can have an idea of what to expect financially. Due to the complexities of insurance contracts, your estimated portion may differ from actual payment by your insurance carrier.
Our staff can also submit inquiries or pre-authorizations to your insurance carrier prior to treatment so you will know whether or not the service you need is covered and how much your insurance plan will pay. Your estimated portion is due at the time of service. Any balance left unpaid by insurance will be your responsibility.
Since we are not a party to the agreement between you and your insurance company, we may ask that you assist us in contacting them in the event that services are not paid within 30 days. As a general policy, insurance claims unpaid after 30 days become the responsibility of the patient.
Should we receive payment from the insurance company and you have already made payment for that date of service, we will prepare a refund for any overpayment and send it to you.
If you have any questions regarding Danville Dental Associates’ policy regarding insurance plans, please contact us.
If you do not have dental insurance and you are a “self-pay” patient, we ask that you pay the entire balance at the time of treatment, unless payment plan arrangements are made with one of our finance managers.
Find Your Plan
Missed Appointments, Cancellations, and Late Arrivals
Missed appointments, cancellations, and late arrivals are a tremendous loss for a practice. Please help our office reduce those losses by canceling with at least 24 hours of notice if you cannot keep your appointment. Failure to give notice 24 hours prior to your appointment may result in a $25 fee to be paid by the patient. Late arrivals of more than 10 minutes may result in rescheduling the appointment to another day.
CareCredit and DentalBanc
Danville Dental Associates partners with CareCredit, a third party financing company.
We offer financing with automatic bank and credit card drafts through DentalBanc. It is not a third party financing option. Instead, DentalBanc is a payment management system drafting payments directly from the patient’s checking account or credit card and depositing it into the Danville Dental Associates bank account each month making timely payment on your account worry-free. You can easily check your balance and print receipts directly from DentalBanc’s secure website. Ask one of our finance managers about DentalBanc and decide if it is the best solution for you.
For details regarding these two options, please visit our Financial Agreement page.
Danville Dental Discount Program
Affordable dental care has never been easier!
Our practice has special offers for our patients such as the Danville Dental Discount Program, which can provide another way to save money while also saving your smile.
The Danville Dental Discount Program was established by Danville Dental Associates in an effort to make dental care more affordable for the patients of the practice. Our discount plan has no annual limits, no application fee, no waiting period, and everyone is accepted, regardless of age or the condition of their teeth. It is a great option for people who do not have access to a dental plan through an employer.
Simply pay the annual fee in full in advance, sign the plan agreement, and your account is activated. If you come to our practice for general dentistry, children’s dentistry, or any of our other services, you can save money with the plan. It covers simple preventive treatments such as cleanings and x-rays as well as complex treatments such as root canal therapy, crowns, porcelain veneers, dentures, bridges, and orthodontic work.
Discounts range from 10% to 20% depending on your method of payment. Refer to our Danville Dental Discount Program brochure for further details.