BARBARA DELUCIA DENTISTRY NEW PATIENT INTAKE FORM
A Master of The Academy of General Dentistry
DENTISTRY FOR PEOPLE AGES 55 and ABOVE
THANK YOU for contacting us for an appointment.
Our office is ‘ Dedicated to Preserving Your Teeth ‘ through health and restorative services.
We are a small, one dentist, private practice. >>( )> . Dr DeLucia is a cosmetic restorative dentist... and yes Dr DeLucia performs all the dental cleanings.
***We only treat people ages 55 and above *** as Dr DeLucia has a special interest in the diseases and disorders of people within this age group.
We only intake a certain number of each insurance to avoid the office being inundated with any single insurance. We give equal opportunities to all the insurances.. Any changes in insurance will require the patient to be inactivated and reactivated into the office on the month that we begin to take that insurance again. All insurance changes must be presented prior to making your next appointment to determine eligibility to re-enter the practice under that plan.
Oh....and one more thing....if you have another dentist in another state or country please be aware that for our patients to remain a patient, ALL x-rays and ALL restorative treatment must be performed by Dr DeLucia once you are a patient of record.. Cleanings can be performed by a dentist in another location to help our patients that are 'snow birds' or ''southern country birds'. This is important for treatment consistency and predictable results. Thank you for understanding our responsibility to you as our patient.
We need some information prior scheduling you into our office.