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Patient Form
Please help us be prepared for your first appointment by completing this Patient Information and Medical History form. Download the form below to your computer, print it out, complete the form, and bring it with you to your first appointment.
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Examination & Consultation
At your first visit with Dr. Gonzales, a thorough examination with complimentary panoramic & cephalometric x-rays & photos of your teeth will be taken. This will help Dr. Gonzales determine the best course of treatment. If in fact you are ready to begin treatment we will then take impressions to make study models of your teeth. This information is all used to develop a custom treatment plan for each patient. These records are also helpful in tracking the progress of treatment as the teeth move under orthodontic care.
Regular Appointments
The appointment when you get your appliances (braces, expanders, etc.) usually takes from one to two hours. You'll then see us at regular intervals 4 to 8 weeks apart for an adjustment, which takes 20 to 30 minutes. Our regular office hours are Monday to Thursday from 8 AM to 5 PM. Patients are seen by appointment only. We pride ourselves in being on time for our patients, and ask that you extend the same courtesy to us. If you cannot keep an appointment, please notify us immediately. Cancel only if it is an emergency. It is difficult to reschedule you since most appointments are made 4 to 8 weeks in advance.
Payment & Office Policies
Cost
The cost of treatment depends on the complexity of the patient's problem. You will be able to discuss fees and payment options before treatment begins. We have payment plans to suit different budgets, including a no-down-payment option. We also accept assignment from most insurance plans, and file the necessary papers to the insurance company. We work hard to make orthodontics affordable.
Fees
In an effort to keep orthodontic fees down while maintaining the highest level of professional care, we have established this financial policy:
- If full payment is made at the onset of treatment, we will offer a fee discount. (If you have insurance, we will offer a discount for payment of your portion of the fee that will not be covered by insurance.)
- To fit your individual needs, financial arrangements can be made to extend your payments over a period of months.
- For your convenience, we accept payment by all major credit cards.
- In cases of serious delinquency, treatment will be suspended, although we will make every effort to accommodate patients with temporary difficulties.
Insurance
If you have insurance, we will help you to determine the coverage you have available. We ask that you assign your insurance benefit to us. The balance will be arranged for you to pay (see above). Professional care is provided to you, our patient, and not to an insurance company. Thus, the insurance company is responsible to the patient and the patient is responsible to the doctor. We will help in every way we can in filing your claim and handling insurance questions from our office on your behalf.
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David. A. Gonzales, DMD, MS, Orthodontist
1919 Oakwell Farms Pkwy Suite 240 | San Antonio, TX 78218 | Tel: 210.824.6787
800 N Bryant St. | Pleasanton, TX 78064 | Tel: 830-281-2500
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