If you are a new patient to our office, please print and complete the forms contained in the file on our New Patient Forms page link below. Simply click on the link and download the pages for printing. We request that these forms be completed by the time you arrive at our office for your appointment. Printing them, filling them out and bringing them with you allows us to expedite your registration process and affords you time to complete the forms at your leisure.

If you have any questions please call our office at 602.277.9088. Thank you.

New Patient Forms  (Print & Complete Prior To 1st Appointment)

Referral Form (Tell A Friend About Dr. Benting)

This web site uses files in Adobe Acrobat Portable Document Format  (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.


 

Since our practice depends upon reimbursement from our patients for costs incurred in their dental care, financial responsibility on the part of each patient must be determined before treatment begins. 

Payment Options

Dr. Benting recognizes the commitment you are making to quality dentistry by accepting his services, therefore we offer several payment options to suit your needs. Our office accepts cash, personal checks, money orders, Visa and Mastercard credit and debit cards, American Express and Discover cards. We also accept dental financing through Care Credit and CitiBank offering up to 24 months of interest-free financing and extended financing for up to sixty months subject to approval. We are happy to recommend a financial plan tailored to the dental treatment presented and your personal needs. Payment is expected at the time services are performed. When more extensive dental care is necessary, financial arrangements can be made with our office.

Insurance

As a service to our patients, our practice accepts most dental insurance programs, including non-managed care, indemnity (traditional) and PPO out-of-network. We are not part of any managed care network. Our accounting staff will prepare all the necessary forms for your dental benefits. However, we remind you that your specific policy is an agreement between you and your insurance company. Please keep in mind that you are responsible for your total obligation should your insurance benefits result in less coverage than anticipated. Our staff will gladly submit a pre-treatment estimate to your insurance company so that you will know what your benefits will be.

The fees charged for services rendered to those who are insured are the usual and customary fees charged to all our patients for similar services. Your policy may base its allowances on a fixed fee schedule, which may or may not coincide with our usual fees. You should be aware that different insurance companies vary greatly in the types of coverage available. Also, some companies take care of claims promptly while others delay payment for several months.