Patient Forms

Below you will find our new patient forms. Feel free to print and complete the forms before your first visit with us. While we do not require that you complete this paperwork prior to visiting our practice, this will save you and our staff time when you come in for your appointment.

Patient Information

New Patient – First Visit

Your initial appointment will be scheduled with Dr. LeBourdais' hygienist. This appointment will include any necessary x-rays, a comprehensive exam by the doctor, and a routine six month cleaning unless more extensive treatment is needed.

Please complete the new patient forms provided on this page, and bring them to your scheduled appointment.

X-Rays & Previous Records: If your previous dentist has taken x-rays, you may request that they forward them to our office. If there is not enough time, please pick them up and bring them to our office. If additional films are necessary, they can be taken at our facility.

Scheduling

Brunswick Dental Health Associates is open Monday through Thursday from 7 a.m. until 5 p.m., and Friday 7:00 a.m. until 3:00 p.m. We will schedule your appointment as promptly as possible. If you have pain or an emergency situation, every attempt will be made to see you that day.

We try our best to stay on schedule to minimize your waiting. Due to the fact Brunswick Dental Health Associates provides many types of dental services, various circumstances may lengthen the time allocated for a procedure. Emergency cases can also arise and cause delays. We appreciate your understanding and patience.

Please call 207-729-6531 with any questions, or to schedule an appointment.

Financial Policy

For your convenience we accept cash, checks, debit cards, and Visa or MasterCard. We deliver the finest care at the most reasonable cost to our patients; therefore, payment is due at the time service is rendered unless other arrangements have been made in advance through outside financing sources. We are unable to schedule payment arrangements in the office. We provide financing services through Capital One or CareCredit. If you have questions regarding your account, please contact us at 207-729-6531.

Please remember you are fully responsible for all fees charged by this office regardless of your insurance coverage.

We will send you a monthly statement. Most insurance companies will respond within four to six weeks. Please call our office if your statement does not reflect your insurance payment within that time frame. Any remaining balance after your insurance has paid is your responsibility. Your prompt remittance is appreciated.

Insurance

Your dental plan is a form of compensation provided by your employer. The amount your insurance will pay is determined by the contract between your employer and the insurance company. The higher the premium paid by your company, the more generous the reimbursement.

Although we are not a party to the contractual arrangement with your insurance company, we do want to help you receive the maximum reimbursement to which you are entitled. As a convenience to you we will process your insurance claims in order for you to receive this maximum benefit. We will also gladly provide dental x-rays and a written diagnostic report should your insurance company have any questions about the services provided.

Infection Control

Infection control and universal precautions protect clients and staff alike. Everyone benefits from rigorous infection control – you, your dentist, and the dental team. The cornerstone in a good and safe dental practice is the element of trust. You should feel free to discuss this topic with Dr. LeBourdais and receive a straightforward answer.

Dr. LeBourdais and our entire team follow procedures recommended by several federal agencies: the Occupational Safety & Health Administration (OSHA), the Environmental Protection Agency (EPA), and the Centers for Disease Control (CDC). These measures include disinfectant hand soap, gloves and face masks, chemical disinfection of countertops and surfaces, sterilization of all equipment before every use, and disposable materials.

We sterilize all reusable equipment, including dental hand pieces. We use an autoclave, a device that kills bacteria and viruses by steam, heat, and pressure.

The best defense against disease is information. The more you know, the better equipped you are to make wise decisions about your health care. The more you know about our daily procedures and policies, the more comfortable you will feel.