New Patients

/New Patients
New Patients 2022-06-28T18:51:25+00:00

We are now accepting new patients! If you would like to become a patient, please fill out the online form below and submit.

Please remember that insurance is not a substitute for payment. Some companies pay fixed allowances for a certain procedures and others pay a percentage of the charge. It is your responsibility to pay any deductible amount, co-insurance or any other balance not paid by your insurance company. This signature on file is authorization for the release of information necessary to process my claim. I hereby authorize payment directly to the doctor named on the benefits otherwise payable to me. There will be $50.00 charge for any returned checks. If there is a returned check, it must be paid in full, along with the $50.00 returned check fee in cash within 24 hours or it will be turned over to the Sheriff's Department for collection.
I authorize my surgeon and his/her designated staff to perform an oral and maxillofacial examination, for the purpose of diagnosis and treatment planning. Furthermore, I authorize the taking of all x-rays required as a necessary part of this examination. In addition, if medically necessary, I authorize the release of any information acquired in the course of my examination and treatment. This signature on file is authorization for the release of information necessary to process my claim. I hereby authorize payment directly to the doctor named on the benefits otherwise payable to me. There will be $50.00 charge for any returned checks. If there is a returned check, it must be paid in full, along with the $50.00 returned check fee in cash within 24 hours or it will be turned over to the Sheriff's Department for collection.
I hereby request and authorize the release of all information regarding any physical and mental condition, as revealed by your observation or treatment, past, present or future. This includes photocopies of medical and/or dental histories, x-ray findings, diagnosis, treatment, prognosis and financial records.
Signature of Patient or Personal Representative

Need Help?

If you have any questions at all, feel free to contact us directly to answer any of your questions and ease any of your fears at [email protected] or via phone at 229-878-3610.

Locations and Contacts

Albany Office

620 Pointe North Blvd.
Albany, GA 31721

Phone: 229.796.0896


Thomasville Office

418 Remington Ave.
Thomasville, GA 31792

Phone: 229.796.0897


Tifton Office

1809 Old Ocilla Rd
Tifton, GA 31794

Phone: 229.796.0904