New Patient Information
Your First Visit
Your initial appointment will consist of a consultation explaining your diagnosis and treatment options. In most cases we will be able to both examine and clean your teeth in the same appointment. If you have two family members wishing to visit our office, we always have two and sometimes three excellent hygienists available making it possible for your whole family to take care of their appointments at the same time! Frequently this is convenient for families that don’t want to make a whole day out of getting teeth cleanings. Call now for an appointment.
- Please assist us by providing the following information at the time of your consultation:
- Please fill out the health history form via the link below. (Online)
- Your referral slip and any X-rays if applicable. (We can call your former office for you)
- A list of medications you are presently taking.
- If you have medical or dental insurance, bring the necessary completed forms. This will save time and allow us to help you process any claims.
- Let us know in advance if you have been advised to take antibiotics before a teeth cleaning.
IMPORTANT: A parent or guardian must accompany all patients under 18 at the consultation visit.
New Patient Forms
You may preregister with our office by filling out our secure online patient registration form. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. On your first visit to our office, we will have your completed form available for your signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.
Online Registration Form
We Work With Insurance
At Dr. Bacon and Dr. Lerud‘s dental office, we make every effort to provide you with the finest care and the most convenient financial options. If you and your loved ones are covered by a dental insurance plan, we want you to know we are your biggest advocate when it comes to maximizing your benefits. Our team of experts will work diligently with your provider to ensure you get the most out of your investment.
Many dental offices in Flagstaff ask you to pay in full and get reimbursed from your insurance company. Not us. We have most Flagstaff and the northern Arizona area insurance schedules in our system and can compute the expected insurance payment at the time of or before your dental procedure. You are responsible for your payment at the time service is rendered unless other arrangements have been made. The expected payment from an insurance company is only an estimate and you will be responsible for the portion the insurance company does not pay. We will file and process claims for all PPO plans and Premier plans (excluding AHCCCS Dental).
Please contact our office to discuss your insurance coverage in detail. They are well informed and up-to-date. They can be reached by phone at 928-440-1367.
Please bring your insurance information with you to the consultation so that we can expedite reimbursement.
For your convenience, we accept Visa, MasterCard, American Express, and Discover. We also work with CareCredit which offers 6 month interest free financing. We deliver the finest care at the most reasonable cost to our patients. Therefore, payment is due at the time service is rendered unless other arrangements have been made in advance. If you have questions regarding your account, please contact us at 928-774-1168. Many times, a simple telephone call will clear any misunderstandings.
Please remember you are fully responsible for all fees charged by this office regardless of your insurance coverage.
In most cases, we provide the exceptional service of filing insurance for you and waiting for the expected insurance payment from the insurance company. We have most Flagstaff and surrounding area insurance schedules in our system and can compute the expected insurance payment at the time of or before your dental procedure. You are responsible for your payment at the time service is rendered unless other arrangements have been made. The expected payment from an insurance company is only an estimate, and you will be responsible for the portion the insurance company does not pay.
We will send you a monthly statement. Most insurance companies will respond within four to six weeks. Please call our office if your statement does not reflect your insurance payment within that time frame. Any remaining balance after your insurance has paid is your responsibility. Your prompt remittance is appreciated.
The Flagstaff Downtown Dental team offers fair and competitive pricing on all of our services, and we do our utmost to help patients defray out of pocket costs by maximizing dental insurance benefits. If you need to finance the costs of your treatment, we are happy to work with CareCredit, a third party dental and medical financier, to offer low and no interest financing options for qualified patients. You can click the link below to pre-qualify, or ask about CareCredit at your next appointment.
Apply for CareCredit