For payment, we accept cash, personal checks, money orders, and most major credit cards (Visa, Mastercard, Discover, and American Express). Payment is expected at the time services are performed unless other financial arrangements have been made with the office.
New Patient Form
Please print and fill out the new patient form with this link
New Patient Form and bring it with you for your first appointment. Thank you.
Transfer of X-Rays Form
If needing to send x-rays to our office, please contact your previous dental clinic to request the transfer. Otherwise, please print and fill out the Transfer of X-rays form with this link
Transfer of X-Rays Form and send the form back to us as soon as possible. Thank you.
We are in-network with various dental insurance companies, including but not limited to:
- Assurant / SunLife Financial
- Delta Dental Premier/PPO/FEP/Various States
- Health Partners (some plans)
- United Healthcare
Please contact our office for more insurance details and questions.
Pure Dental Discount Plan (Pure Dental Discount Plan Brochure)
We provide a convenient plan (for patients without access to dental insurance) to invest and protect your teeth for your future. This plan includes two routine cleanings and two exams with x-rays and 10% off all other dental work.
- Two (2) Routine Cleanings
- Two (2) Exams
- X-rays as Needed
- 10% Off All Other Dental Work
- No Yearly Maximum Benefit
- No Deductible
- Cosmetic Dentistry Included
First Year Savings $230!
Your first year savings are a minimum of $230 for your semi-annual cleanings and exams with x-rays.
Percent Off Discount
Cleanings (2 per 12 months) 100%
Comprehensive Exam (New Patients) 100%
Periodic Exams (2 per 12 months) 100%
X-Rays (All types) 100%
All other dental procedures are 10% off including the list below:
Porcelain Crowns and Build-Ups
Veneers and Bridges
Dentures and Partials
Yearly Membership Dues
First Family Member $395.00
Additional Family Member $375.00
Note: All family members must live in the same household. All membership information will be kept in your electronic record. Pure Dental Discount Plan benefits start the day you purchase the plan and ends one year (365 days) from the purchase date.
Terms and Limitations
- The Pure Dental Discount Plan (PDDP) is NOT dental insurance. It cannot be combined with insurance plans or any other special offers.
- The PDDP is an annual plan. It begins the day you enroll and ends one year (365 days) from purchase date.
- Any and all services offered under the PDDP that are not utilized within the 12-month period are forfeited. There are NO exceptions, NO refunds, or NO adjustments granted.
- PDDP is NON-Transferable. Family members cannot be substitutes for another family member.
- Two broken appointments without a proper 48-hour notice will lead to termination of membership in PDDP, and no refund will be given.
- Payments for all services are due at scheduled appointment.
- Should there be dental treatment needed following any type of injury where a lawsuit and therefore outside medical care, disability, or workman’s comp type insurances are involved, PDDP can not be used.
- Rates are subject to change annually.
- For orthodontic treatment, participant must remain a PDDP member the entire duration of the treatment.
- Dental services only, products are not included.
- Please see the PDDP Membership Form for full list of Terms and Limitations.