Thank you for choosing Midwest Dental. For your convenience this section includes forms you’ll need during your first visit, as well as what to expect when you come for your appointment. If you still have any questions about your visit, please call your Midwest Dental office. We’re here to help.
If this is your very first appointment with us, please arrive 15 minutes before your scheduled appointment. This will allow us to finish any paperwork and stay on schedule with your appointment.
Your first appointment duration varies, but please plan on 1 to 1.5 hours.
Please bring the following items with you to your first appointment:
• Dental Insurance Card (If applicable)
• Identification (Driver’s license, military ID or state ID)
• Patient Health History Form
• Adult Health Form / Spanish
• Child Health Form / Spanish
• HIPAA Form / Spanish
• Financial Policy / Spanish
• Privacy Practices
If you require pre-medication before your appointment, please be sure to request a prescription prior to your appointment, or if you are unsure, contact us and we can help. Please read below for more information.
Midwest Dental accepts most dental insurance plans,* including plans from:
*This is not a comprehensive list, and is subject to change.
After your appointment, we will submit your claim to your insurance company. If you have a deductible or a co-pay due for services provided, those fees are due at the time of service. We provide you with a complete estimate before any treatment is performed, and we make every effort to maximize your dental benefits. However, each employer designs their own dental plan. To completely understand what is covered by your dental benefit plan, it is best to contact your employer or insurance company. Please contact your insurance provider to verify coverage and acceptance.
For services not covered or not submitted to insurance, we accept cash, check or major credit cards. We do ask for payment at the time of service.
For patients without insurance, we offer an exclusive in-house dental discount plan. The Essential Smile Plan provides you and your family access to the dental care you need at a discounted rate. Members will receive 50% off dental exams and 30% off cleanings, X-rays and other preventive procedures, as well as dentures and implants. Plus, receive 20% off all other services from any participating provider at Midwest Dental, Mountain Dental®, Merit Dental® and Mondovi Dental® practices nationwide.
The best part is because this isn’t insurance you’re guaranteed acceptance and you can use the plan right away. Visit essentialsmileplan.com to learn more and join the plan today.
*Not available in Augusta, Baldwin, Blaine, Decatur, Janesville, Madison East, Mankato, Racine North Bay, Shawano, St. Charles, Vernon Hills, Wells, Wisconsin Rapids, Wisconsin Rapids, Midtowne.
Have you been putting off needed dental work because you can’t afford it? Midwest Dental accepts CareCredit, which offers you the flexibility of monthly payments. CareCredit offers promotional financing for 6, 12, 18, or 24 months* on qualifying purchases of $200 or more [after discount] at enrolled provider locations made with your CareCredit credit card account. Please read and understand the CareCredit terms and financing options.
Visit www.carecredit.com for more information, or click the CareCredit icon on your Midwest Dental office page to apply now.
*Subject to credit approval. Minimum monthly payments required. See carecredit.com or ask your provider for details.
