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Dental Emergencies Welcome
Accepting New patients
Family & Cosmetic Dentistry
8301 Whitley Road, Fort Worth, TX 76148
An Appointment

New patient Information

New Patient Information Required

When you call our office to schedule your visit you will need

  1. The information for the person responsible for the bill, if it is not you
  2. We will need the name and information of whomever is going to be seen at our office.
  3. Their name address and phone number
  4. Their email address
  5. Their date of birth and gender
  6. Concerning the Social Security Number – We will not need your social security number unless you have an insurance carrier that uses this number as your insurance coverage ID. Also if you don’t know who your carrier is, we can look it up under your social security number, so we will only need it for insurance reasons.
  7. How you found out about us. By the way, we appreciate any friends or family members you can send our way.
  8. We will need whatever insurance information you have that you can give us. If you don’t have dental insurance, we have an in-office dental plan that you can still save money on your dental treatment.
  9. If you’d like to complete your dental forms in advance of your visit. Tell us when you call your first time and we will set up your account on our patient portal which gives you access to the dental program that we use at our office. You can complete the forms there.
  10. When you completing your new patient forms, we will need your health history and a list of any medicines you are taking. You will also be required to sign a HIPAA waiver and an Informed Consent for treatment, which lists possible complications that could occur during your dental treatment.
At your first visit you can complete your health history and patient information forms on our Tablet PC in our reception area. It only takes a few minutes, or as said previously you can complete them on our website patient portal in advance of your visit.
Using the Patient Portal

As we said, some people with large families prefer to complete their new patient forms online, before their visit. 

You can directly access the dental software program we use at our office.

Here are the steps to do this:

  1. You will need to call us first, so we can set up your account, but it is really fast.
  2. Go to this page on our website and click on the button marked “Access Patient Portal“.
  3. Your login ID is your email address on the window that comes up next.
  4. Next click on “create or forgot password”.
  5. You will then be prompted to enter your email address again.
  6. A pop up will say check your email for instructions to set your password.
  7. Go to the email you receive and click on the link that starts with http. You will be prompted to set up a password for your access to the patient portal. Click Submit.
  8. It will then have a pop-up that says, “Your password change was successful”. Click the button that says, “Click here to continue”.
  9. No you will log into your account with your email address and new password and Bingo, you are in and ready to go.
  10. So click on the name of the person you are entering the information for. You can add other people later on and fill out their forms.
  11. Now click on “Patient Forms”.
  12. Complete the “Patient Health History”. If it has been more than a year since you went to a dentist, then we don’t need the name of your former dentist. Include your physician’s name though in case of emergencies and the rest of the form.
  13. Now click “Next” at the top of the form.
  14. Now complete the Medical Conditions page and write in the patient’s name at the bottom. Click next at the top.
  15. Complete the Patient Registration Information. Click Next.
  16. Supply us with as much Insurance Information as you can. Many carriers don’t issue dental insurance cards anymore, so we can help you with this. Just leave it blank if you don’t know or you don’t have any insurance.
  17. Sign the Insurance Information release and HIPAA privacy policy, by typing in your name at the bottom.
  18. Click Finish and you are done!
  19. Go to profile and complete that form if you want us to text you a reminder of your dental appointment time. Then click Submit.
  20. If you have additional family members that you would like to add besides yourself, then call us and we will set them up under your family and you will see their name come up on the list that first appears. You can complete a new patient form for each family member that wishes to be seen at our office.
If you encounter any problems while using the portal, just sign out and then sign back in again, or contact us if you need help.