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New Patient Information

To be seen at the clinic, you must live in Douglas County, Kansas and meet income guidelines based on federal poverty levels. We accept KanCare and commercial dental insurance. Our fees are set on a sliding scale based on your income and fees are due at the time of service.

New patients 18+ must first see the dentist for an examination and X-rays before any other appointments for non-emergency cleanings, fillings, etc. can be set.

We require that you fill out our new patient paperwork and bring it in, along with a photo ID, proof of Douglas County residency, and your most recent tax return before we can set up a new patient appointment.

If you are unable to provide a tax return, please note that we can use other forms of proof of income (check stubs, vision card, etc.) but we will only be able to offer our sliding scale based on a household of one person. Please talk to a member of our front desk team if you are unable to bring in your tax return and we will discuss options with you.

Paperwork can be submitted until 4pm Monday – Thursday and until 3pm on Fridays. Click below to view and print out our patient paperwork.

New Patient Paperwork

Notice Of Privacy Practices

Bring the completed forms to the clinic and we’ll be more than happy to setup an appointment if you meet eligibility requirements.  The document is formatted in Adobe Acrobat format.  If you don’t have Adobe Acrobat Reader on your computer, please click here.

Fees

Our fees are greatly reduced and offered on a sliding scale according to your income.  While we do offer services at a reduced rate, the services are not free and payment is due at the time of service. We accept cash, check, or credit card. We will give you a treatment plan with all of the prices for procedures you need once our doctor has completed an exam and X-rays.