Mesa, AZ (Arizona) Dentist Gary A. Robison, DDS—Robison Dental Group
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Please help us be prepared for your first appointment by completing this Patient Form. Download the form below, print it out, complete the form, and bring it with you to your first appointment.

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Welcome to our practice. In our continuing efforts to provide comprehensive dental care to you, our valued patients, we ask that you become acquainted with our office policies. If at any time you have any questions, please feel free to ask so that we may better serve you. All recommended treatments are in the best interest to our patients. We will not allow insurance companies to dictate treatment, and so we will inform you of the fees before we perform all procedures. We will assist you in your payment options to help you receive the treatment that is necessary for your needs. Please note that no two mouths are alike; therefore, we will customize treatment to suit your individual needs. Also, we have developed our new website which provides a very convenient way to access your account and information.

Dental Insurance

We accept assignment of estimated insurance benefits as a courtesy to our patients, provided that you submit a completed original insurance claim or card. Please note that your dental insurance is a contract between you and the insurance company, not between your dentist and the insurance company. Our usual and customary fees are a reflection of our commitment to excellence, which is modest with the geographical area. If for any reason your insurance company fails to pay for services rendered, you are responsible for all payments. All estimated co-payments and deductibles are due when service is rendered.

Preferred Method of Payment

For you convenience, we accept personal checks (with proper I.D.), cash, debits, and all major credit cards. As an added courtesy, we also offer a revolving line of credit through a third party, Credit Care (upon approval). This line of credit allows you to start treatment today and spread payments over a comfortable period of time. There will be a twenty dollar ($20.00) returned check fee applied to your account in the event that the bank denies your check.

General Appointments

We reserved appointment time especially for you and your specific dental needs. When you cancel on short notice, other patients that needed treatment cannot be seen and the time and money we pay to our staff and for overhead is wasted. Therefore, we ask for your consideration and that you kindly give us a 48-hour notice if you are unable to keep your appointments. Please note that if a proper notice is given, the forty-two dollar ($42.00) broken appointment fee will be waived.

 

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