New Patient Forms

Your first visit to Gordon Dentistry establishes a vital foundation for our relationship. During your first visit, we will review your medical history and document any medications or herbal supplements you may be taking so that we are aware of any conditions that may impact your oral health.

You can save time at your first visit by completing and printing out the dental patient forms in advance of your appointment.

So that we may verify your dental insurance benefit, please email a copy of the front and back of your insurance card to [email protected] We will contact your insurance company and verify whether we will be an in-network or out-of-network provider for you. If you do not have an insurance card, you can provide us with the following to verify your benefits:

• Patient Name, DOB, Subscriber number or Social Security number
• Insured person’s name, DOB, Subscriber number or Social Security number
• Employer Name and Group number
• Insurance Company Full Name (Example – Delta Dental of Illinois)
• Insurance Company Phone Number
• Claims Address
• Payor ID

The American Heart Association updated their recommendations for antibiotic prophylaxis to prevent infective endocarditis in April 2007. The following conditions warrant antibiotic prophylaxis: prosthetic cardiac valves, history of previous infective endocarditis, severe or unrepaired congenital heart disease, completely repaired congenital heart defect with prosthetic material or device during the first six months after the procedure, repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device, cardiac transplantation recipients who develop cardiac valvulopathy. Patients with a history of heart attack or stents or bypass surgery generally do not require antibiotic prophylaxis. Click below to learn more.

Click below to download the Total Joint Replacement Form.