Patient Form

Click Here to fill out your patient form online.
Download your patient form in PDF format.

We accept all PPO insurance.

We are in-network with the following PPO insurance:
Ameritas
Aetna
BCBS
Cigna
Delta Dental
Guardian
MetLife
Principle
United Concordia

We are also a provider for:
MCNA for TX Medicaid & CHIP
Dentaquest for TX Medicaid & CHIP