Smile Beautiful Dentistry Karessa Kuntz
Smile Beautiful Dentistry Monroeville

Schedule your appointment :    Call: 412.372.7192   Online


New Patient Forms:Please remember to complete these forms before your first appointment. When you hit the submit button, your information is safely sent to your chart in our office. If you have any problem with these files, please call our office and we will gladly send or fax them to you.


Registration:

 

Patient Information Patient Information Patient Medical History Form Medical History

If you would like to use insurance benefits please make sure to include the full dental insurance details including ID/Social Security Number.

 


General Information:

 

Patient Consent FormPatient Consent Form Notice of Privacy Notice of Privacy
Financial Policy Form Financial Policy Form Financial Policy FormPatient Survey

Procedure Specific Forms:

These forms need only be completed prior to a specific treatment.

 

Extraction Agreement Extraction Agreement Implant Replacement Agreement Implant Placement Consent Pt 1
Root Canal Agreement Root Canal Consent Basic Dental Consent Implant Placement Consent Pt 2

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

  • Any dental records and x-rays that you may have. If your records and x-rays are at another office, please obtain a copy and bring them to your initial appointment.

Your initial appointment will consist of an exam and consultation, which will include:

  • Any necessary x-rays, photos, and models
  • An exam of your teeth and gums
  • A discussion about your concerns
  • A consultation and a treatment sequence

IMPORTANT: All patients under 18 must be accompanied by a parent or guardian during the consultation visit.


Insurance:

At Smile Beautiful Dentistry, we make every effort to provide you the most convenient financial options. To accomplish this we work hand-in-hand with you to maximize your insurance reimbursement for covered procedures. We accept most nationally recognized P.P.O. dental policies including United Concordia, UMPC, Met Life, Delta, Aetna and Guardian. Please bring your insurance information with you to the consultation so that we can expedite reimbursement. Please note that payment is due at the time of treatment.


Patient Billing:

Convenient Financial Options are always available. For your convenience we accept most major credit cards, personal checks and cash.

Affordable financing can be obtained through the use of Dollar Bank Financing and Care Credit. Please speak to our Office Manager for details.