Forms

Wilkinson Dental

All patients are required to complete forms  regarding medical and dental history, and other forms regarding information privacy, insurance if applicable and a registration form.  For your convenience the necessary forms can be viewed via the blue links provided below. Each is a pdf file that can be printed off. Please review the brief descriptions to select the correct form(s) suitable for you. We hope this will provide a convenience for you and make your visit with us more pleasant.

Please contact us if you have any questions at (906) 226-9935.

 

All patients should complete the following:

Adults need to complete the following:

Parents or Guardians please complete the following for your child:

 

Estimates / Billing / Insurance  concerns

The cost of an initial exam will vary depending on the number of radiographs taken and whether or not a cleaning is completed at that time. Although it is impossible to determine the exact charge in advance, we can give you an estimate of the cost before you are seen. Our office does participate with Blue Cross Blue Shield, Delta Dental insurance, and we accept cash, checks, and major credit cards. We will do our best to help you understand your dental insurance plan.

Payment is due each visit. We accept cash, checks, Visa and MasterCard. We will bill your insurance carrier directly. We request payment of your deductible and co-payment  at the time of service. We also will assist in filing other insurance claims for your reimbursement. If full payment is not feasible at the time of your visit, we can make payment arrangements.

We encourage all patients to call the office to discuss concerns regarding fees, billing or payments. We want to work with you to ensure that financial concerns do not impede proper dental care.