New Patient Forms
Note to Patient: There is a “Save and Exit” feature on this form, that would allow you to complete any portion of this form at a later time before submitting this information to our office. At a minimum, you will need to input your first name, last name, DOB, email and at least one phone number field (home or cell phone). Once this is filled out, you will notice a button labeled “Save & Exit” appear in the upper right hand corner of the form . If you choose to select this button, our system will send you a registration email which you can setup and login at any time to finalize your registration form online.
What to Expect at Your First Visit
Your first visit will consist of a consultation where we review your medical history, take x-rays, diagnose your symptoms, and prepare a treatment plan. Sometimes, surgery can occur the same day as your consultation, but that is not the norm. Typically, treatment will be provided at a second appointment. Here are the steps you can take to ensure that your initial appointment goes smoothly:
- Bring your surgical referral slip and any x-rays if applicable.
- Provide a list of medications you are currently taking.
- If you have medical and/or dental insurance, bring the necessary completed forms. This will save time and allow us to help you process any claims.
- Bring your drivers license.
- If the patient is under 18, you must be accompanied by a parent or guardian.
- If your current dentist or medical provided has taken x-rays, please have those sent to our office ahead of your appointment.
For your convenience, we accept Cash, Check, Visa, and/or MasterCard. We deliver the finest care at the most reasonable cost to our patients, therefore payment is due at the time service is rendered unless other arrangements have been made in advance. If you have questions regarding your account, please contact us at Hickory Office Phone Number 828-327-7867 or Morganton Office Phone Number 828-433-4499. Many times, a simple telephone call will clear any misunderstandings.
Please remember you are fully responsible for all fees charged by this office regardless of your insurance coverage.
Most insurance companies will respond within four to six weeks. Please call our office if your statement does not reflect your insurance payment within that time frame. Any remaining balance after your insurance has paid is your responsibility. Your prompt remittance is appreciated. We can make arrangements for a monthly payment plan, but that must be implemented prior to the actual procedure.
Please click on the following link to view and apply for CareCredit.
We make every effort to provide you with the finest surgical care and the most convenient financial options. To accomplish this goal, we work hand-in-hand with you to maximize your insurance reimbursement for covered procedures. If you have any problems or questions, please ask our staff. They are well informed and up-to-date.
Please bring medical and dental insurance information with you to the consultation, so we can expedite reimbursement.
Legacy Oral & Facial Surgery will gladly file claims for the following dental plans:
- Blue Cross Blue Shield (dental only)
- Cigna PPO
- Delta Dental Premier
- Delta Dental Preferred
- NC Medicaid (please provide our practice with a written referral from your general dentist and your current Medicaid card)