New Patient Forms
At your first visit, we ask you to fill out and sign a Registration Form, Medical Health History, Financial Agreement and HIPAA Privacy Notice Acknowledgement.
To save time, simply click to download this packet, print out and complete, and bring the them with you to your appointment.
Frequently Asked Questions
What are your office hours?
Our office is open from Monday – Thursday : 8:00 am to 4:30 pm.
What kind of insurances do you take?
Connection Dental Network is leased by many other providers and, through that contract, we are considered “In-Network” for many insurance companies not listed below.
We accept most other insurance as well, utilizing our standard fee schedule.
Currently, our In-Network insurances are…
- DELTA DENTAL PREMIER
- BLUE CROSS/BLUE SHIELD OF ARKANSAS
- METLIFE
- CIGNA
- GEHA (CONNECTION DENTAL NETWORK **)
- HEALTHCHOICE OKLAHOMA
- HUMANA
- MHBP (Municipal Health Benefit Plan)
What methods of payment do you accept?
We accept the following forms of payment for services…
- Cash
- Personal Checks
- Visa ~ Mastercard ~ Discover
- CareCredit (For patients needing a payment plan, qualification required)
How can I contact the office?
You can send us a message using our online form, or please always feel free to call our office at 479-452-3368.
For After Office Hours Emergencies call 479-883-8951.
Do you offer emergency care?
Yes. For any after-hour emergencies, please call 479-883-8951.
Need an Appointment?
Leave your name and email below along with what times and days work best for you. Or you can call us at 479.452.3368.
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The healing process begins the moment a tooth is removed. After an extraction, the body sends blood to nourish the tooth socket and a blood clot is formed. This clot is an important part of the normal healing process.
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2414 South 58th Street, Ft. Smith, AR 72903
