New Patient Form

It is your responsibility to know what benefits your insurance covers, how often services can be performed, annual maximums, and percentages.

I have read the above and agree to accept responsibility for my dental account. “My dental account” is defined as any costs incurred by any and all persons or family members receiving dental treatment and or receiving benefits on the same insurance plan at any time. Should any conditions change, I agree that it is my responsibility to notify Beach Grove Dental of these changes before any costs are incurred.