Patient Forms

 

Thank you for choosing Payne and Payne Dentistry.  We look forward to seeing you soon. 

Please read the following information and remember to bring the necessary items with you.

Please be 15 minutes early for your first appointment.  Inform the front desk that you are a new patient and turn in your paperwork.

Please complete the paperwork to the best of your ability.  If you need additional help or have any questions, please see someone at the front desk and they will be happy to assist you.

Please provide the front desk with a copy of your current dental insurance card and a valid photo ID.

In order to file your insurance, please provide the front desk with the subscriber's name, birth date, and social security number.

If you do not have an insurance card, please provide following information:    

    a. Insurance Company name
    b. Insurance Company address
    c. Insurance Company phone number
    d. Group number or any ID numbers associated with your insurance contract.

 

Click on the following links to print forms:

HIPPA Form

Patient History Page 1

Patient History Page2

Office Policies

Financial Policy