Patient Forms

Hello,

We are excited that you are interested in becoming a new patient of our dental practice.  Slavin, Jackson, Burns, DDS is dedicated to high quality dental care in a state of the art facility with a knowledgeable and caring staff.

Your initial visit is scheduled with a NYS licensed dental hygienist.  At this appointment, we will be obtaining the necessary information needed to make a complete and thorough diagnosis.  As you know, dental oral health is significantly related to your general medical condition.  Therefore, a complete oral evaluation is essential to your overall health.

The initial visit will consist of the following:

1. Comprehensive head and neck exam
2. Periodontal screening exam
3. Full mouth series of radiographs
4. Panorex radiograph
5. Oral cancer screening
6. Prophylaxis/Dental Cleaning (IF TIME ALLOWS)

These diagnostic tests, radiographs and preventive procedures are essential for establishing baseline information needed to assess your oral health.

In our office all fees are due as services are rendered.  As a courtesy to you we will assist you by submitting your claim to your insurance provider to receive your maximum benefit.

Once again, on behalf of the entire practice we look forward to helping you achieve optimum oral health.

Sincerely,

Dr. Slavin, Dr. Jackson, and Dr. Burns

DOCUMENTS

Medical Records Release Authorization Form
Patient Forms