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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
Welcome
Form
Please fill this out and turn it in at the front desk for your child when you arrive for your appointment.  3/1/2009  Here
Adult's
Registration
Form
Please fill this out and turn it in at the front desk when you arrive for your appointment. 3/1/2009 Here
HIPAA Notice
of Privacy
Practices
Please fill this out and turn it in at the front desk when you arrive for your appointment. 3/1/2009 Here
New Patient Information Information for our new patients about our fees, insurance and billing. 6/3/2014 Here
Nota de HIPAA
de Practicas
de Intimidad
Por favor, rellene esto y convertirlo en la parte delantera escritorio cuando usted llegue a su cita. 3/1/2009 Aqui
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. 1/1/2008 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. 1/1/2010 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.

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