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New Office Hours! Monday - Thursday 7AM - 4PM, Closed Friday, Saturday and Sunday

Patient Forms

All the Patient Forms are available to download.  You can fill out the paperwork ahead of time and turn it in when you arrive for your first appointment.  This will help us to get you in to your appointment as soon as possible.If you would prefer, you can print out, complete and sign our patient forms to speed up checking-in for your first visit so we can get you in to see Dr. Buchwald as soon as possible. If available, please remember to bring in your insurance card when you come in, so we may make a copy of it for our records. We accept Medicaid for children. Most dental insurance is accepted. We accept Aetna, Assurant, Blue Cross Blue Shield (BCBS), Careington, Cigna, Delta, Dental Wellness, Dental Network of America, Dentamax, Guardian, Humana, Metlife and United Healthcare.

  Description Last Updated  Download 
Children's
Health History
Update
Please fill this out and turn it in at the front desk for your child when you arrive for your appointment. 6/2/2020 Here
Adult's
Health History
Update
Please fill this out and turn it in at the front desk when you arrive for your appointment. 6/2/2020 Here
HIPAA Notice
of Privacy
Practices
Please fill this out and turn it in at the front desk when you arrive for your appointment. 6/2/2020 Here
New Patient Information Information for our new patients about our fees, insurance and billing. 6/2/2020 Here
Financial Policy
Form
To keep our fees as low as possible, payment is expected on the date services are initiated. In some instances, we may ask that you prepay for your dental services to reserve special appointment times... This form needs your signature. 6/2/2020 Here
Credit Card
 Pre-Authorization 
Form
This optional pre-authorization policy was created in response to many of our patient's desire to not be billed for small balances on their accounts remaining after all insurance payments have been made. As a convenience to you, this form provides us with the authorization to charge your credit card for outstanding balances up to $99.00 if this occurs. 6/2/2020 Here
No Show
Policy & Fees
When our office books your appointment, we are setting aside a dedicated chair and time slot just for you. We only ask that if you must reschedule your appointment, that you please provide us with at least 24 hours’ notice to avoid the fee. 6/2/2020 Here
Bone
Graft and
Membrane
An information and consent form for Bone Graft and Membrane patients. 6/12/2020 Here
Bridge An information and consent form for Bridge patients. 6/12/2020 Here
Buildup
Post and
Core
An information and consent form for Buildup Post and Core patients. 6/12/2020 Here
Composite
Filling
An information and consent form for Composite Filling patients. 6/12/2020 Here
Crown An information and consent form for Crown patients. 6/12/2020 Here
Gingivectomy An information and consent form for Gingivectomy patients. 6/12/2020 Here
Implant An information and consent form for Implant patients. 6/12/2020 Here
Indirect
Pulp Cap
An information and consent form for Indirect Pulp Cap patients. 6/12/2020 Here
Limited
Exam
An information and consent form for Limited Exam patients. 6/12/2020 Here
Night
Guard
An information and consent form for Night Guard patients. 6/12/2020 Here
Nitrous An information and consent form for Nitrous patients. 6/12/2020 Here
Oral
Surgery
and EXT
An information and consent form for Oral Surgery and EXT patients. 6/12/2020 Here
Periodontal
Maintenance
An information and consent form for Periodontal Maintenance patients. 6/12/2020 Here
Root
Canal
An information and consent form for Root Canal patients. 6/12/2020 Here
SC RP An information and consent form for SC RP patients. 6/12/2020 Here
Click here to get the Acrobat Reader for free! Documents are in .pdf format. Adobe® Acrobat® Reader® is free software that lets you view and print Adobe Portable Document Format (PDF) files. Click here to download it for free.

 

 

Read All About It!Dr. Max Buchwald is great with children. Kids love him. Adults too! See the newspaper article in the Dallas Morning News reporting the way Dr. Max works with kids so they are not afraid of the dentist and like to come for check ups. He takes the fear out of going to the dentist.

Invisalign is clearly your best choice for a better smile!Invisalign® is the best way to transform your smile without interfering with your day-to-day life. Check out the benefits here