Kiddsmiles Pediatric Dentistry

Dear Parents,

Thank you for choosing our office to care for your child’s dental care. We are delighted to welcome you to our dental family and appreciate the opportunity to provide your child with quality dentistry and a comfortable and fun experience. Our desire is to enter into a partnership based on trust and mutual responsibility. Please know that your child’s needs come first at our practice.

The following forms are enclosed:

*Medical/Dental history
*Patient privacy form (HIPPA)
*Consent to treat your child
*Insurance information

Please complete these forms and bring it with you to your appointment so that we have all the information needed to serve your child better. For your convenience we have also enclosed an appointment card confirming your visit. In addition for our patients that do not have insurance, full payment is due at the time of your visit, if you have insurance preventative is usually covered 100%, you will however be responsible for any co pay and deductible on the day of your visit if restorative treatment is recommended for your child.

Our office policy on appointments is as follows, we understand emergencies happen however, please try and give our office 24 hours notice if cancelling or rescheduling your appointment, if you have a Saturday appointment kindly try and give 48 hours notice. Unfortunately without notice you can be charged $50.00 per child for a broken or missed appointment.

If you have any questions for us prior to your appointment please do not hesitate to call. Again, thank you for entrusting Kiddsmiles Pediatric Dentistry with your child’s dental care. We look forward to meeting you and your family.

Sincerely,
Kiddsmiles Pediatric Dentistry

For your convenience prior to visiting our office, please click on the following forms, complete the information and bring them with you to your first visit.

New Patient Health History Form
Patient Consent Form
HIPAA Notice of Privacy Acknowledgement Form
Records Request Form

To print the form you will need Adobe Acrobat Reader. If you do not have Adobe Acrobat, please click here to download it for free to your computer.

Kiddsmiles Pediatric Dentistry, Dr. Michele Savel
Serving children in the Manhasset and North Babylon areas of NY

Click here to read our Disclaimer. Click here to read our Privacy Policies and Procedures.

Web Site Designed by Dentists4Kids.com