Patient Information and Forms
At Your Community Dental and Brown & Associates DDS,PLLC, we want every experience you have with our practice to be comfortable and efficient.
In order to make your first as time-efficient as possible, we ask you to carefully review, complete and sign our New Patient Forms before you arrive. You can fax the completed forms to us in advance, to 910-342-9211 or simply bring them along with you to your appointment.
Our Patient Information Forms provides us with you contact information and medical history. By signing, you also authorize your insurance company to pay us their designated portion of fees for the service we’ve provided to you. Our Financial Policy gives you an understanding of our polices and expectations.
Our Privacy and Disclosure Form (HIPA) is our legally-required description if how your health information maybe use and disclosed by us.
If you have any questions about any of these documents in advance of your first visit, please contact us at 910-342-9210.
Everyone at Your Community Dental and Brown & Associates, DDS, PLLC looks forward to the privilege of serving you, providing you with the highest quality of care and at the most affordable way possible.
Your Community Dental and Brown & associates, DDS, PLLC accepts most major insurance plans. We recommend that you ask one of our associates for specific information about your policy before initiating treatment. If you do not see the name of your insurance provider listed below, please be sure to let us know, we are always adding more providers to our service list.
All co-payments are due at the time of treatment. Fees due must be paid in cash, approved check, credit card or Carecredit. As a courtesy, we are happy to file your insurance claims for you.
Insurance companies we work with are:
- Ameritas Group
- Benefit Administrative Services
- Blue Cross
- Companion Life
- Delta Dental
- Lincoln Financial
- Reliant Standard
- Principle Life
- Sun Life Financial
- United Concordia
- Wells Fargo TPA
Your Community Dental and Brown & Associates DDS, PLLC have service the Medicaid community consistently since 2000 with the specific objective to provide quality dental and oral hygiene services to members of every segment of the area population.
We believe everyone deserves quality dentistry at fair and affordable prices. Our caring, experienced professionals are committed to providing accessible superior dental care.
Your Community Dental welcomes Medicaid payment. A current Medicaid card is required to be treated. If you do not bring a copy of your card we reserve the right to reschedule you to another day.
Adult Medicaid patients need to make their $3.00 copay payment at the time of receiving treatment.
If you have any questions about our Medicaid policy or practice procedure at any time, please do not hesitate to contact Your Community Dental at 910-342-9210. Your Community Dental and Brown & Associates DDS, PLLC strive to provide outstanding oral hygiene and dental treatment for all residents of our community in the most affordable, compassionate and professional manner. We serve members of the entire family, ages four and up.
Your Community Dental believes everyone deserves quality dentistry at fair and reasonable fees. We manage our practice cost effectively and forego unnecessary “extras” to keep our fees reasonable and as low as possible. When treating our patients, we discuss treatment options with the most economical option that is practical for their specific situation.
In order to manage our practice as cost-effectively as we can, we accept the following forms of payment at the time of service:
- Approved Check
- Credit Card
All copays are due at the time of visit
We also welcome Medicaid payment. Adult Medicaid patients need to make their $3.00 copay payment at the time of receiving treatment.
All Medicaid and Insurance patients are required to bring a copy of their current card to each visit; we reserve the right to reschedule if you do not have your card at the time of visit.
In your patient paperwork you will sign a copy of our Financial Policy. If you have any questions about our payment or financial policy, please do not hesitate to contact Your Community Dental at 910-342-9210.
Patient Referral Program
A referral is the highest compliment that we could receive. It shows the confidence our patients have in our service and care we provide to you our patient. The team of Brown and Associates promises daily to give each and every patient the highest quality of care and respect. We thank you for selecting Brown and Associates as your Dental Care Team and look forward to seeing you at your next visit with us.
In-House Dental Savings Plan
Dr Brown offers an in-house dental health savings plan for those patient that do not have dental insurance. This plan allows you the patient to receive treatment at a discount cost. Please ask a team member for more details.
Schedule Your Visit
Have a question? Call us at 910.342.9210