NEW PATIENT INFORMATION
YOUR FIRST VISIT
During your first visit to Doctor Haley, you will become familiar with our office, our staff and our methods. We will make a great effort to ensure that you feel comfortable during your visit.
We understand that each patient’s treatment is different, and we promise to give you the personal attention you deserve. Your first visit will consist of an examination and discussion of potential treatment options.
Reviewing Treatment Options:
Once Dr. Haley establish his findings, he will review his findings with you and recommendations to you. After treatment options have been thoroughly explored, you will receive a detailed treatment plan, which includes all recommended treatments, costs and insurance information.
Fees for Preventive Services (cleaning, x-rays, and periodic exams) must be paid in full at the time service is rendered. You will receive a completed insurance form that you can file with your insurance company directing all reimbursements to you.
Restorative and Cosmetic Dentistry: (fillings, crowns, periodontal therapy, oral surgery, etc.) fees must be paid as follows:
Option 1: Payment of your portion only:
•Payment of estimated patient portion is due at time of service.
•Any balance not paid by insurance will be due upon notification.
•We will file the insurance claim for you.
Option 2: Payment in full with Discount:
A 5% discount will be given for full payment (cash or check) of restorative and cosmetic procedures at the time of service. Should you choose this option, you will be provided with a completed insurance form for self-filing and insurance reimbursement.
A 3% discount will be given for full payment with a credit card for restorative and cosmetic procedures at the time of service. Should you choose this option, you will also be provided with a completed insurance form for self-filing and reimbursement.
Financing available for people without Dental Insurance:
For those procedures that cost $1,000 or more, financing is available through an independent lending source called Dental Fee Plan. For more information, please click on the Dental Fee Plan Button to your left or contact our office.
I value our continued partnership in fulfilling your dental care needs and appreciate your cooperation in this matter. Should you have any questions,please do not hesitate to contact my office
John C. Haley, D.D.S.
new patient forms
For the first visit, please take the time to complete the appropriate New Patient Information forms listed as links below. Completing the forms prior to your arrival will allow your initial visit to begin more promptly without delay.
Click on each BUTTON below. Print out, Fill out and bring the forms with you when you visit Doctor Haley.
It is our desire that each and every patient rests confidently in our efforts to maintain the highest level of performance in sterilization and housekeeping.
The first line of patient protection in the treatment room begins with the use of disposable barrier covers on all patient contact surfaces, as well as, disposable air/water syringes and disposable evacuation tips. After each patient, all barriers are changed and each treatment room is disinfected with an appropriate surface disinfectant aimed at cross contaminants. The product used is a germicidal, broad spectrum, anti-bacterial, fungicidal, virucidal and tuberculocidal disinfecting solution.
All staff members must wear appropriate personal protection equipment including mask and eyewear. New gloves are put on prior to initiating treatment and are discarded upon leaving treatment area. After each patient, all instruments are debrided by Ultrasonic cleaner. All handpieces and instruments are then processed by Chemiclave sterilization, which utilizes chemical, heat and pressure. The Chemiclave is maintained and monitored daily and biologically tested off site on a regular basis.
We invite you to ask questions about our techniques and procedures at any time.