Patient Info

Thank you for choosing HollowBrook Family Dentistry as your dental care provider.

New patients
You can download and fill out this 2-page form and bring it with you to our office.

Download New Patient Form (PDF)

Please print and fill out this 2-page form and bring it with you, along with your insurance card/information, when you come for your first appointment.

We will see you then!

Payment Information
We strive to give you the finest care at the most reasonable cost. Therefore, payment is requested at the time services are rendered.
We happily accept Cash, Check, Visa, MasterCard, Discover and American Express.

We can also make arrangements for a monthly payment plan for large balances. Please ask us about payment plans before we schedule your treatment.

Insurance Coverage
Some or all of the costs of your treatment may be covered by your insurance provider. We strongly encourage you to determine if your provider “participates” with our office. We may be able to help you find this out.
Please provide our front desk with your current insurance information during your first visit and let us know about any changes thereafter.
We are happy to submit a claim to your insurance company, but this does not necessarily mean that we “participate” with your insurance company. If you do have dental insurance, we will file your claim as expeditiously as possible. But please keep in mind that your policy is a contract between you and your insurance company.
Please also remember that you are fully responsible for all fees charged by this office regardless of your insurance coverage. Any remaining balance after insurance has paid is your responsibility and your prompt remittance is appreciated.

CareCredit©
We are registered with CareCredit, the nation’s leading medical and dental care financing program. You can find information about applying for a no-interest CareCredit plan at: http://www.carecredit.com. Our office offers 3 months interest-free for procedures under $300 as well as 6 and 12 months interest-free for procedures over $300.00.
You can easily apply at our office, online or over the phone for this great no-interest program.

Questions? Ask Us.
We appreciate the opportunity to care for you and your family, and encourage you to contact us if you have any questions regarding finances.