Patient Forms

First Visit

Your initial appointment will consist of a comprehensive examination to determine if root canal treatment is necessary and if the tooth is a good candidate for root canal treatment.

In some cases, treatment can be done the same day of the consultation. However, a complex medical history or treatment plan will require an evaluation and a second appointment to provide treatment on another day.

Please assist us by providing the following information at the time of your consultation:

• Your referral slip and any X-rays if applicable.
• A list of medications you are presently taking.
• If you have dental insurance, bring the necessary completed forms. This will save time and allow us to help you process any claims.

IMPORTANT: A parent or guardian must accompany all patients under 18 at the consultation visit.

Please alert the office if you have a medical condition that may be of concern prior to treatment (i.e. diabetes, high blood pressure, artificial heart valves and joints, rheumatic fever, etc.) or if you are on any medication (i.e. heart medications, aspirin, anticoagulant therapy, etc.) or require medication prior to dental cleanings (i.e antibiotics, for pre-med.)

X-Rays

If your dentist has taken recent x-rays (within 6-months), you may request that they forward them to our office.

Scheduling

Office Hours

Monday through Friday: 8:30 AM - 5:00 PM

Saturday through Sunday: Closed

Endodontic Associates is open Monday through Friday 8:30 am to 5 pm. We will schedule your appointment as promptly as possible.

If you have pain or an emergency situation, every attempt will be made to see you that day.

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Online Forms

Patient Registration

Please download and fill-out our Patient Registration Form. After you have completed the form, please make sure to bring it on your first visit to our office. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Patient Registration Form

Dental Insurance

Please download and fill-out our Dental Insurance Form. After you have completed the form, please make sure to bring it on your first visit to our office. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Dental Insurance Form

Technical Note:

You need Adobe Acrobat Reader to view our form. Please download the free Acrobat Reader from Adobe’s web site if it is not already installed on your system.

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HIPPA Privacy Practices Notice

Notice of Privacy Practices