Forms & Payment Options

New Patient Forms

• New Patient Info
• Appointment Policy
• Payment and Insurance
• Photo Consent

HIPAA Forms

• Notice of Privacy Practice
• Protected Health Information

Payment Options

We accept Visa, Master Card, Discovery, American Express and Care Credit.

Please click the CareCredit image to fill out an online application.

Insurance Options

Preferred providers (PPO) for the following insurance companies:

1. Delta Dental
2. United Concordia
3. Metlife
4. BCBS of Nebraska
5. Dentemax
6. Ameritas

Most insurance coverages are accepted and processed.
Contact your insurance provider to verify your eligibility at our office.

Gift Cards

Now available. Give the gift of a beautiful smile!!