New Patient Information
What to Expect
Your first visit to Winnetka Dental Group Ltd. is an important one as it introduces you to our practice and our friendly staff. During the first visit, we will collect background information like medical history as well as take the time to get to know Dr. Czarkowski. Below you will find additional information to view before your first visit to Winnetka Dental Group LTD. Also, to help ensure your first visit goes as smoothly as possible, we invite you to take a few minutes to explore our website to educate yourself about the some of the dentistry and smile solutions we offer.
In order to make your visit an easy process, you can request an appointment from our website or call our office. Our friendly staff will assist you in getting everything set up.
For your appointment, please bring with your most recent set of full-mouth X-rays and your completed health registration forms.
Insurance, Payments, & Financial Arrangements
Our office accepts all major credit cards except American Express.
In order to provide the highest quality care in the most accessible manner, we have developed a full range of convenient payment options for you to choose from. Prior to the commencement of treatment, financial arrangements will be discussed with you. Our front desk is also ready and willing to help you with any questions you may have about your insurance benefits. We accept cash, Visa, MasterCard, Discover, and personal checks, and we also offer interest-free payment plans both in office and through Care Credit.
Do not hesitate to ask about the anticipated investment in our dental health. You have the right to know and understand our fees for care. We strive to treat our patients as we would want to be treated and we want you to feel that you have been treated fairly. We will gladly give you a written treatment plan including an estimate for any necessary care upon request. For those with dental insurance benefits, a pre-determination of benefits can be obtained to calculate your out of pocket investment for recommended treatment. We ask for an initial payment for more involved and extended treatment, regardless of insurance coverage or pre-determination of payment by your insurance company. Our dental team thanks you for your understanding and cooperation.
What is the difference between in-network and out-of-network providers?
An in-network provider is one contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates. An out-of-network provider is one not contracted with the health insurance plan.
Typically, if you visit a dentist or other provider within the network, the amount you will be responsible for paying may be different than if you go to an out-of-network provider.
As a courtesy, our office will submit all dental claims on your behalf. We will also include any necessary documentation and/or attachments for prompt reimbursement.
Please refer to your Insurance Benefit’s Handbook for further details.
The below patient forms can be printed and completed before your first visit to expedite your check-in process:
- Patient Registration & Medical History Form
- HIPAA Privacy Form (PDF Version Available Here)
- Financial Policy
- Financial & Cancellation Policy
- Supplemental Informed Consent
- Supplemental Health Questionaire
We look forward to your first visit!