Insurance and Patient Information Forms

Let’s get you organized with the necessary forms below.
We want to facilitate and streamline your transition to our Eguren Dentisty family!

How do we assist you with insurance?

For your convenience, we will gladly assist you in submitting both predetermination and initial insurance claims pertaining to charges for care rendered in our office.
However, please be aware our primary financial relationship is with our patients or their families and not with their respective insurance companies. Final responsibility for collection of benefits from your insurance company rests with the insured party.
Our professional services are rendered and charged directly to the patient or their family and they are responsible for payment of all fees incurred. For facilitation of payment, we offer these payment arrangements:

How does orthodontic insurance work?

There are many different agreements between insurance carriers and their subscribers, and each contract provides a different benefit. However, orthodontic insurance generally differs from regular dental insurance in that each insured individual usually has a lifetime maximum benefit for orthodontic services. This benefit is paid as a percentage of the orthodontic fee (diagnostic records, initial fee, monthly payments, etc.) until the benefit maximum has been reached. Charges for lost or broken appliances may not be covered by insurance.

Forms for New Patients

To make your first visit as swift as possible, please download and complete the following forms:

Information Consent Form

Medical Consent Form

Dental and Hygiene History