For New Patients
Patient Information
Everything you need to make your first visit with Merlo & Fahrney Dentistry smooth and straightforward.
Thank you for scheduling your first appointment with Merlo & Fahrney Dentistry. We wanted to drop you a quick note to welcome you into our family and to make sure your first visit goes smoothly.
Below you can find links to our New Patient forms we would like you to fill out and bring with you to the appointment. It is no big deal if you do not, but this could save you some time and hassle when you arrive. If you have any issues opening the attachments please contact our office at (704) 372-5411 or by emailing [email protected].
Before Your Visit
New Patient Forms
Download, print, and complete before your visit. Bring the forms with you, or send the Records Release Form ahead of time so we can retrieve your prior dental records.
Download the Records Release Form
If you have been to a dentist within the past few years, please complete this form and send it to our office via fax, email, or paper mail as soon as possible. This form allows us to retrieve your records from your previous office.
Download the Notice of Privacy Practices
Our Notice of Privacy Practices explains how medical information about you may be used and disclosed and how you can get access to this information.
Coverage
Dental Insurance
If you have dental benefits, please complete the dental insurance portion of the registration form and bring your insurance card with you to your appointment.
Our office will file all PPO commercial insurance. However, we are only contracted providers for:
- Delta Dental
- Cigna PPO (Radius Network)
- Blue Cross Blue Shield of North Carolina PPO
As a courtesy to our patients, we will contact your insurance company to verify your coverage and benefits. Payment will be based on the terms of your insurance plan. You will be responsible for your estimated co-payment at the time services are rendered. Any fees not covered or paid by the insurance company thereafter will be your responsibility.
Payment
Payment Options
Our office offers several payment options to cover the cost of treatment and all balances not covered by your insurance. We accept:
- Cash
- Check
- Visa
- MasterCard
- Discover
- American Express
- CareCredit
Financing
CareCredit
CareCredit is a convenient, low minimum monthly payment program for your entire family, specifically designed to pay for healthcare and elective treatment not covered by insurance. CareCredit, the leader in patient financing, has made it easy for more than four million patients nationwide to get the treatment that they need. For treatment fees from $1 to over $25,000, CareCredit has a variety of low minimum monthly payment plans, so you can start treatment today.
With CareCredit You Can
- · Pay for co-payments, deductibles, and treatment not covered by insurance
- · Start treatment immediately and pay over time with low minimum monthly payments
- · Pay for other healthcare expenses for you and your family without having to reapply*
- · Reserve existing credit cards for household or unplanned expenses
- · Have no annual fees
If you have any questions regarding our policies please do not hesitate to contact us.
We wish to make your time with us pleasant and informative. Again, thank you for selecting our dental health care team. We are looking forward to seeing you, and we will do everything we can to make your visit quick and comfortable.
Schedule Your Visit
Ready to Schedule Your First Visit?
Call the office at (704) 372-5411 or request an appointment online. We are happy to answer questions about forms, insurance, or payment before you come in.