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Insurance & MedicaidSame-Day EmergenciesWalk-Ins WelcomeOpen Saturdays

New Patient Information

Are you visiting one of our Central Texas dental offices in Belton, Harker Heights, Killeen, Taylor, Temple, or Waco for the first time? We look forward to welcoming you to our extended family. To make your first visit more convenient, we’ve made our new patient forms available here on our website for you to download. We invite you to complete them before arrival, so we can begin processing them as soon as you come in. If you have any trouble downloading or opening our forms, let us know and we can fax or mail them to you instead.

Download Our Forms

We've made our forms available online to help you skip the time in our waiting rooms! Please complete all the necessary paperwork prior to your first visit by downloading and printing each document below. We’ve separated our forms for English and Spanish speaking patients, in addition to segmenting them depending on your dental coverage.

Important Note: Please make sure to complete the correct forms based on your benefits coverage (PPO insurance, Medicaid/CHIP) and age of the patient. If you have any questions, don’t hesitate to contact one of our central Texas Belton or Taylor offices to confirm which forms are right for you.

English Forms

New Patients (PPO Insurance, All Ages)

CHIP & Medicaid (Under 3 Years Old)

CHIP & Medicaid (3-6 Years Old)

CHIP & Medicaid (6-18 Years Old)

Formas en Español

Nuevos Pacientes (PPO Seguros, Todas edades)

CHIP y Medicaid (Menores de 3 años)

CHIP y Medicaid (3-6 años)

CHIP y Medicaid (6-18 años)

Dental Insurance and Payment Options

One of the most common questions we receive from new patients is: do you accept my insurance? We understand how important dental benefits are to many of our patients. As such, we do accept ALL PPO Insurances, MEDICAID & CHIP Insurances including:

Medicaid and CHIP Accepted

We also accept Medicaid, CHIP, and we offer affordable payment plans with 0% interest and monthly payments designed around your budget. We also file a claim with your provider regardless of whether or not we accept your plan. We’re dedicated to helping you maximize your benefits.

If you have any questions about your plan or about financing options, don’t hesitate to let a member of our team know. We do what we can to see that questions or concerns are resolved. We’re happy to accept payment with cash, personal check, and all major credit cards.

Care credit

Take control of the health your mouth deserves. With the CareCredit healthcare credit card, you can benefit from special dental financing options. The advantages of using CareCredit includes:

Click here to directed to the CareCredit website. 

Click here to download CareCredit forms.

*Subject to credit history

Convenient Hours

We’re happy to offer hours that are convenient for anyone with a busy schedule at both of our locations. Whether you need to reserve an evening appointment or Saturday appointment, we can accommodate you.

In accordance with Section 1557 of the Patient Protection and Affordable Care Act, our office provides interpreter services, through the assistance of your health plan, for the following non-English languages…

  • Spanish
  • Vietnamese
  • Chinese
  • French
  • Tagalog
  • Korean
  • African Languages
  • Urdu
  • Arabic
  • Hindi
  • Gujarathi
  • Persian
  • Japanese
  • Russian
  • Italian

The category "African Languages" includes Amharic, Ibo, Twi, Yoruba, Bantu, Swahili, and Somali.