Important forms and information regarding your care at our office.
Our practice offers a full scope of periodontal and dental implant services. Using the latest techniques and state-of-the-art equipment, we provide a pleasant, warm, and caring environment. We study the latest techniques in periodontics to provide you with the most advanced dental care and diagnosis.
Our goal is to make you feel comfortable and relaxed and to ensure that your surgical and administrative needs are met as efficiently and as smoothly as possible. We are here to listen to your questions and concerns and to help provide solutions leading to better dental health. Please don't hesitate to call us at (925)398-8903 if you have any questions regarding your care.
Scheduling Dr. Schellinck is available Monday through Thursday from 8:30 am to 5:00 pm. We will schedule your appointment as promptly as possible. If you have pain or an emergency situation, every attempt will be made to see you that day.
To expedite your consultation, please print and fill out the following new patient forms here.
In addition, please assist us at the time of your initial visit to the office by providing the following:
• Your referral slip, if given to you by your referring dentist • We will request x-rays from your referring dentist, however, additional x-rays may need to be taken. • If you have dental insurance, please bring any forms or insurance cards with you to the appointment.
Please note all patients under the age of 18 must be accompanied by a parent or guardian at the consultation appointment.
Please notify the office if you have a medical condition or concern prior to treatment (e.g. artificial heart valves or joints, heart murmurs requiring pre-medication, severe diabetes, or hypertension).
If you have dental insurance you must realize that your insurance is a contract between you, your employer, and the insurance company. We are not a party to that contract. Our staff will be happy to discuss all insurance details with you at your appointment.
Co-Payment At your request your treatment plan will be submitted to your insurance company before treatment to determine the amount the insurance company will pay. All co-payments will be due at the time of treatment. As a courtesy we will submit insurance for payment after treatment. If the insurance company defaults in full or partial payments, or fails to pay within a period of time three months after treatment was provided, payment will be due from you at that time.
Patient Billing We will send you a monthly statement. Most insurances will respond within four to six weeks. Please call our office if your statement does not reflect your insurance payment within that time frame. Any remaining balance after your insurance has paid is your responsibility.
For your convenience we accept payment via cash, personal check, Visa and Mastercard. If you have any problems or questions, please ask our staff. They can be reached by phone at (925)398-8903.