Forms, Insurance and Payment Options

Save time before your appointment. You can fill out a new patient form in the comfort of your own home.

New Patient Forms

Please complete the appropriate questionnaire ahead of time to help expedite your visit.

Adults – English

Children – English

Adults – Spanish

Children – Spanish

If another adult is accompanying your child to his/her appointment(s), please fill out this form ahead of time.

Minor Child Consent Form

Insurance

ClearCare Dental PLLC Dentistry is happy to accept dental insurance. In fact, our team is well-versed in the nuances of insurance, so we’ll file and track your claims for you, in addition to verifying your benefits to give you and accurate estimate of your treatment cost. Please bring your insurance card or information to each appointment so we can make sure your patient file is up-to-date.

We accept the following dental insurance, in addition to many others. Call our office to find out if we accept your plan!

Third-Party Financing

Out-of-pocket expenses can catch you off guard but they shouldn’t stop you from getting the quality dental care you need and deserve. Our practice is happy to accept third-party financing through CreditCare®. This option works like a credit card for your healthcare expenses. They offer low and no-interest plans, as well as extended repayment options. Visit their website to learn more and complete the quick and easy online application.

Loyalty Program

Not everyone has dental insurance, or if they do, it might not be enough to let them get the care they need. That’s why we offer in-house dental loyalty plans. Call our office at 540-785-4494  today to learn more