Patient Forms

New Patient Resources 

Please complete the following forms and either email them to us at info@citrusdentalinv.com, bring them to your appointment, or mail them to:

Citrus Dental of Inverness, 2231 Hwy 44 W, Unit 101, Inverness, Florida 34453

The Notice of Privacy Practices is yours to keep. If you have children who may be in the office without a parent present, please read and sign the Parental Permission form.

Appointments

Your scheduled appointment time has been reserved specifically for you.

We request a 24-hour notice if you need to cancel your appointment.

We are aware that unforeseen events sometimes require missing an appointment, and appreciate your cooperation.

Request Appointment >

Request Appointment

Transferring Records

To transfer your records to or from Citrus Dental, please complete one of the following forms:

Insurance

Our office is committed to helping you maximize your insurance benefits. Because insurance policies vary, we can only estimate your coverage in good faith but cannot guarantee coverage due to the complexities of insurance contracts. Your estimated patient portion must be paid at the time of service. As a service to our patients, we will bill insurance companies for services.

Share by: