Patient Information


The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete an online appointment request.

Patient Forms

If you are a new patient to our office, the attached file contains our new patient bundle with forms that will need to be filled out when you arrive at our office. Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all.

New patient form (Print & Complete All Forms Prior To First Office Visit) 

Financial Policy form


This web site uses files in Adobe Acrobat Portable Document Format  (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

 Credit CardsPayment Options

For your convenience, we accept cash, debit and credit. Payment is expected at the time services are performed. When more extensive dental care is necessary, financial arrangements can be made with our office.

Dental Insurance

As a service to our patients, our practice accepts most dental insurance programs, including non-managed care, indemnity (traditional) and PPO out-of-network.  We are providers for Delta Premier plan and Aetna PPO.  Our accounting staff will prepare all the necessary forms for your dental benefits. However, we remind you that your specific policy is an agreement between you and your insurance company. Please keep in mind that you are responsible for your total obligation should your insurance benefits result in less coverage than anticipated.

The fees charged for services rendered to those who are insured are the usual and customary fees charged to all our patients for similar services. Your policy may base its allowances on a fixed fee schedule, which may or may not coincide with our usual fees. You should be aware that different insurance companies vary greatly in the types of coverage available. Also, some companies take care of claims promptly while others delay payment for several months.

First Pacific Corporation (FPC) - Partnered Billing

In order to devote more time to providing you and your family with optimal care, we partner with a billing service. First Pacific Corporation prepares and mails your statements, and receives and records your payments. FPC is not a collection agency, but an organization of people available to assist you with any questions or concerns you may have regarding your account.

Should you need additional information or assistance, please contact FPC or download the flyer below. FPC representatives are available weekdays from 6:00 a.m. to 5:30 p.m. PST at the following number: 1-800-574-7064

Learn More About First Pacific Corporation

Please send payments to: First Pacific Corporation P.O. Box 3000 Salem, OR 97302-8001


View More