New Patient Intake Process

Welcome to your Midlothian Dentist!

Thank you for choosing Cedarwood Dentistry! We love welcoming new patients to our family-friendly Midlothian dental practice and strive to make the process a positive and comforting experience. To streamline the process and put your mind at ease, we provide an easy and safe online new patient intake process, as well as a clear explanation of what a new patient appointment entails.

We consider your first visit the start of a long-term relationship, so please follow the simple steps below. We can’t wait to begin!

Step 1: Make an Appointment

Schedule your new patient appointment at Cedarwood Dentistry by calling 804-379-9375 or by filling out the online appointment form. Our Midlothian dental practice is open from 8:00 AM to 5:00 PM on Monday - Thursday and 8:00 AM to 1:00 PM on Friday.
Step 2: Complete Cedarwood's New Patient Paperwork

After your appointment has been confirmed, please help us streamline your care by filling out the new patient paperwork below. Our Midlothian dental practice values a paperless process that increases efficiency, benefits the environment, and, most importantly, protects your information.

"*" indicates required fields

Step 1 of 3

Comments

This field is for validation purposes and should be left unchanged.

Name*

First Last

Date of Birth*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Gender*

Marital Status*

Social Security Number*

Driving License Number*

Please read carefully and sign to acknowledge understanding and agreement Thank you for choosing us as you dental care provider. We are committed to providing you with the best dental care available. Available Payment Options. You can choose from ~ Cash, Check, or Credit Card CareCredit payment plan option, ask us for detailed information. In-House Financing is also available Regarding Insurance. * For covered services, we ask that all co-pays and deductibles be paid on the day of treatment. Since your insurance company may not cover all costs, we ask that you pay any percentage of your balance not paid by your insurance on the day of treatment. * For services that are not covered by your insurance, we ask that you pay the entire fee the day of your treatment. * We will attempt to answer any questions we can about your insurance and, when possible We will assist in resolving complications with your insurance company. Please understand that We cannot Speak on their behalf. Your insurance contract is an agreement between you, your employer and your insurance carrier. In the event that your insurance company has not paid (on your behalf), you will be responsible to pay your account. Patients Without Insurance. * For those patients without insurance coverage, you will be responsible for payment on the day of treatment. If you are not able to pay in full, or if your treatment requires several visits, you will be given an estimate and will be able to discuss payment arrangements with a member of our business office Staff. Cancellation/No Show Policy. * Our office requires notice to cancel your appointment in the case of an emergency. * We reserve the right to charge a fee, for those not giving notice. Collections * A charge will be added to your account for any returned checks. You are responsible to pay all costs of collecting, or attempting to collect any debt owed on this account. This includes all attorneys fees, interest and late fees. X-Rays. * You are responsible to pay a fee for duplicate copies of your X-rays. I hereby authorize payment to Christopher G. Wolberg, DDS, P.C. by the group insurance, otherwise payable to me.

Signature

Step 3: See You at Cedarwood Dentistry!

Once the new patient intake paperwork is complete, you are ready to be seen by our expert team of dentists and hygienists. On the day of your appointment, please arrive five minutes early. If you are unable to keep your appointment, contact us no less than 24 hours in advance to reschedule. We will not re-appoint patients who do not show up for new patient appointments or cancel within 24 hours without just-cause.

Ready for Your First Appointment? Here's What To Expect on Your First Visit to Cedarwood Dentistry!

If you are having trouble completing the new patient form or have further questions about your first appointment, please contact us at 804-379-9375.

If you're interested in reading about our financial options and in-network providers, click here.

Step 1: Make an Appointment

Step 2: Complete Cedarwood's New Patient Paperwork

Step 3: See You at Cedarwood Dentistry!

Ready for Your First Appointment? Here's What To Expect on Your First Visit to Cedarwood Dentistry!