Robert C. Sabatelle, DMD

Aaron S. Osofsky, DDS

Robert C. Sabatelle, DMD

Brett K. Patel, DMD

One Court Street, Suite 270

Lebanon, NH. 03766

Office: (603) 448-1830

Fax: (603) 448-1826

WELCOME LETTER

Thank you for your inquiry regarding our practice. We are a three-partner practice of general dentists committed to comprehensive dentistry for the whole family. We are prevention-oriented and try to deliver top quality care in a cost-conscious manner. To do this, we expect our patients to allow us to do diagnostic films and periodic exams. We are here to serve you and will do our best to alert you of your treatment options.

Enclosed is a packet containing forms that need to be prepared, signed and returned to us prior to your visit. In addition to the completed forms, we will need current films from your previous dentist, or we will need to take them at your first visit.

Before your first visit we will try to review your paperwork, medical and dental history, evaluate your films and your benefit plan. We will be investing quite a bit of time prior to your first visit. We ask that you arrive 15 minutes earlier than the scheduled time to clear up administrative details. We ask you to be responsible for your appointment times and dates as we usually bill for late or missed appointments. To assist you we will attempt to confirm your appointment with the phone, text, and e-mail information you supply to us. Please see our office policy for additional information.

Your first appointment will be a comprehensive exam. After your comprehensive exam, treatment options will be discussed. We will either do an immediate consult, reschedule one consult, or mail you a written treatment plan. You may be charged for additional consults.

Medically complicated patients, latex allergic patients, patients with joint prosthesis, artificial heart valves, or blood thinners should send in the appropriate written list of medications and medical conditions for the doctor to review along with the medical history. For patients that are minors, elderly, developmentally disabled, or who have memory problems, we ask that the parent, driver, or legal guardian must be available during the appointment unless otherwise specified. For minors, the legal guardian or parent must be present for the first few appointments, and available by phone for all other appointments.

If you don’t have Dental Insurance, please bring up to $250.00 to cover your first appointment. Payment is expected at the time of service for all treatment unless we have made other arrangements through our business office.

If you have insurance, the estimated co-pay is due on the day of service. We encourage you to read your dental insurance policy and understand the limits of your dental coverage prior to your dental visit. As a courtesy for all our patients, we will do our best to submit your dental claims and pre-authorize dental procedures for you.

Below is a checklist to help you complete your paperwork. On the following page is a full description of items for the curious. Please return the requested paperwork and files by mail or in person. Upon receiving all the necessary paperwork, we will call you at your current phone numbers to set up an appointment. We cannot do an examination until we receive the completed paperwork and have the current films. After the exam and a discussion of your options, you will be asked to choose a plan of treatment. After you agree to a course of treatment and sign the appropriate consent forms, you will be considered a patient of the practice, and treatment can commence.

Call if you have questions, or need assistance.

ITEMS TO FILL OUT AND RETURN PRIOR TO APPOINTMENT

FORM #1( ) Patient Registration/Medical History Form (Both sides)

FORM #2-3( ) HIPAA Acknowledgement Forms

FORM #6( ) Appointment Policy

FORM #7( ) Additional Questions page

A Materials Data Sheet in included to make you aware that we use multiple materials to restore your teeth and that the amalgam fillings are viewed to be safe. You may opt for plastic tooth colored fillings instead of amalgams. Talk to us about any dental materials that are a concern to you. Please ask us any questions about materials at your first appointment.

ITEMS TO OBTAIN FROM YOUR PREVIOUS DENTIST PRIOR TO APPOINTMENT

A Panorex (panoramic) jaw film of diagnostic quality, less than five years of age is required for all new patients.

Four (4) BWX (bite wing x-rays)of diagnostic value, less than 2 years old.

Your previous dentist may request you complete a form to have x-rays released from them (Further detail is provided on next page).

We will take these records at your first appointment if they are not present for the exam visit, or if they are not of diagnostic value. Additional radiographs may be necessary based on your dental history and condition of your teeth and gums. Stone study models are sometimes necessary to evaluate and plan treatment.

We look forward to meeting you, making your dental experience pleasant, and managing your dental needs.

(#7) PLEASE FILL OUT ALL THE ITEMS BELOW THAT APPLY AND RETURN

1. How were you referred to our office?

______

2. Description of extenuating medical, behavioral, psychological or health history concerns.______

1. The reason you have transferred from your previous dentist and or a description of any failed dentistry and or any reasons you may particularly fear dentistry.

______

4.A list of medications (If they can’t fit on the medical history form)

______

1. Do you have any questions or concerns about dentistry, your dental health, or your smile?

______