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Information is gathered in order to make a thorough assessment and diagnosis. This includes:
Should more than 1-2 simple fillings be required to restore your orofacial system to health, Dr. Wall will analyze your records and create a customized care plan. The fee listed is for care plan creation and accompanying consultation appointment. As it can take Dr. Wall up to 2 hours to complete your treatment plans, this fee must be prepaid prior to Dr. Wall reviewing all your records.
Payment of Fees
If you have dental insurance, some of these fees may be reimbursable. Regardless of insurance
coverage, however, payment for services rendered are due at the time of service. I understand that there is a NON-REFUNDABLE $200 deposit to reserve a diagnostic appointment.
After submitting, feel free to return to the Patient Forms page. Please note, there are multiple forms for each section.