Kokomo Oral & Maxillofacial Surgery, Kokomo IN
Please assist us by providing the following information:
- Your surgical referral slip and any x-rays if applicable. If your dentist or physician has taken x-rays you may request that they forward them to our office. Please be aware that we need an up to date “surgical x-ray” for treatment and that we may need to take our own surgical x-ray even if your dentist has previously taken an x-ray.
- A list of medications you are presently taking.
- If you have medical or dental insurance, if your insurance company provides you with a card, please bring your card so we can make a copy of it for your chart to assist us in submitting your insurance claim. If you do not have a card, please bring your insurance company’s pertinent information.
- It is your responsibility to verify that your insurance plan covers your visit with us. We will submit claims to your insurance providers as a courtesy to you, but we are not responsible for negotiating claims with insurance companies or other persons. Please be aware some services may be “non-covered” services under the provisions of your insurance, but you are still responsible for the charges. In the event that benefits to which Dr. Thompson is entitled are paid directly to you for the treatment performed, you agree to immediately deliver all such payments to our office up to the amount of your indebtedness.
- Please see the Patient Registration section to view, print, and fill out the Patient Information Sheet. Please bring your completed form to your appointment.
- In case of divorce or separation the parent authorizing treatment for a child will be the parent responsible for subsequent charges. Our office is not responsible for billing the other parent.
IMPORTANT: All patients under the age of 18 must be accompanied by a parent or guardian.
A consultation is mandatory for patients undergoing IV anesthesia for surgery.
Please alert the office if you have a medical condition that may be of concern prior to surgery (i.e., diabetes, high blood pressure, artificial heart valves, artificial joint replacement, rheumatic fever, etc.) or if you are currently taking any medications (i.e., heart medications, aspirin, anticoagulant therapy/ blood thinners, etc.).
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