Patient Forms


In order for Dr. Patino to diagnose your dental status, we need to obtain accurate information from you…always kept confidential.  The following forms are required at your initial visit.  You may complete them at your leisure prior to our first appointment. 



In order to view or print these forms you will need Adobe Acrobat Reader installed.

 Insurances

                                                     
  We accept most insurances and their assignments.  As a courtesy to our
valued patients, we submit all insurance claims and do any follow-up that
is needed.  We do a thorough research of your benefits and do our best
to accurately inform you about your insurance benefits and payments.  We are
a fee for service dental practice.  We work directly for our patients and we are
not a preferred provider for any insurance company.  Payments are expected at the time of service.  In addition, we will gladly arrange convenient payment
plans with third party financial companies if needed.  If you have any questions about your insurance plans
and payment options, give us a call. We will be happy to assist you.  

Dental insurance is a contract between your employer and an insurance company.  The benefits you receive are based on the terms of the contract your employer negotiates. Most dental insurance policies provide only basic care and treatment.  The amount of coverage varies, with a typical range of 50 to 80 percent of the total charges.  This dental office did not participate in the negotiations; therefore, we have no influence as to how much, if any, coverage your policy provides. Many services necessary to achieve a high quality, and complete result are not covered. 


Payments


Dental Payment    
Payments are due at the time of service. Applying for financing takes just minutes
 
The following forms are appreciated:


Personal Checks

Cash



      









Schedule Your Dental Appointment Today


Located in Gainesville, Dr. Elizabeth Patino and staff are prepared to offer you complete dental care for a variety of issues.
To schedule an appointment, contact us at 352.331.8683.  We serve patients in Gainesville, Alachua, Jonesville, and surrounding areas.
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