Child Dentistry Dental Forms, ages 0-12

Thank you for choosing our office for your child’s dental care.  At Spring Lake Dental Group, our goal is to start your child on a road to excellent oral health so that they can maintain those habits through their life.  A smile says a lot about a person, and we take pride in making your child look his/her best! Dr. Dickerhoff, Dr. Lewis, Dr. Calabria, Dr. Lindsey, Dr. Vitelli-Rodriguez, Dr. Powell, Dr. Whitehead, Dr. Nichols or Dr. Clark specialize in working with infants, toddlers, adolescents, teenagers, and children with special needs and handle it all from routine cleanings to orthodontics.  To best serve your child’s dental needs our children’s dentists work together to  ensure that  your child receives the best treatment available. Drs. Dickerhoff, Lewis, Calabria, Lindsey, Vitelli-Rodriguez, Powell, Whitehead, Nichols or Clark offer a wide variety of services for our patients including:

  • Preventive Dentistry
  • Nitrous Oxide Sedaton (Laughing Gas)
  • Radiographs (x-rays)
  • Dental Restorations
 
 

Patients under the age of 18 must be accompanied by a parent or legal guardian to every appointment.  A written note with your signature allowing another adult to authorize care for your child is acceptable.

Why should your child visit the Dentist by AGE ONE?

  • One out of four children develop tooth decay by age 3.  (US Attorney General)
  • Childhood decay is 100% preventable!
  • Improper bottle use and sippy cups increase the risk for dental decay.
  • Visit the dentist by age one and avoid unnecessary fear of the dentist later.

Your infant’s dental visit will include:

  • Comprehensive examination and infant toothbrush
  • Infant fluoride therapy and treatment
  • Parental brushing tips and training
  • Diet and nutrition guidance

Drs. Dickerhoff, Lewis, Calabria, Lindsey, Vitelli-Rodriguez, Powell, Whitehead, Nichols or Clark have reserved time for your child to be acquainted with our team during his/her first visit, answer any questions, make your child feel comfortable, and provide a thorough dental examination.  Please arrive 15 minutes before the appointed time to allow for registration, as we want to spend the appointment time for your child’s treatment.  Bring a list of all medications your child takes.  Please forward any existing dental records (to include x-rays) to us before your child’s initial visit.  Records can be mailed, faxed or emailed to [email protected].

Payment is required at the time of treatment.  Drs. Dickerhoff, Lewis, Calabria, Lindsey, Vitelli-Rodriguez, Powell, Whitehead, Nichols or Clark accept most insurance plans, VISA, MasterCard, American Express, Discover, CareCredit, and cash.   Please become familiar with your dental insurance plan as there may be plan limitations, frequencies, waiting periods, and maximum coverage amounts that will affect your out-of-pocket cost share.  Drs. Dickerhoff, Lewis, Calabria, Lindsey, Vitelli-Rodriguez, Powell, Whitehead, Nichols or Clark are available to help you understand your dental plan if needed.

Finally, it is important to play a part in preparing your child for his/her visit to the dentist.  Act relaxed and at ease.  Avoid using words that suggest unpleasantness.  Drs. Dickerhoff, Lewis, Calabria, Lindsey, Vitelli-Rodriguez, Powell, Whitehead, Nichols or Clark will explain our procedures to children in terms they understand, before we perform them.  Drs. Dickerhoff, Lewis, Calabria, Lindsey, Vitelli-Rodriguez, Powell, Whitehead, Nichols or Clark can overcome any apprehension your child may have when we work together.  Expect your child to do well and enjoy his/her visit to our office, as it is very likely that he/she will. Drs. Dickerhoff, Lewis, Calabria, Lindsey, Vitelli-Rodriguez, Powell, Whitehead, Nichols or Clark treat you and your family as we treat our own.  Together we can give your child a beautiful smile and a lifetime of dental health.

Forms to complete now, before your visit:

  1. Child Dentistry Registration and Health History
  2. Financial Arrangements and Insurance