Patient Registration-New Patient Forms
Scott A. Reef, DDS, MSD and Justin J. Villanueva, DMD, MSD, DHL — Periodontal Associates of Lafayette IN
Insurance/Guarantor and Medical History Information Forms
We have an “Opt-out” status with Medicare. We cannot file claims with Medicare, nor can our patients for treatment. Dental procedures are not normally cover under traditional Medicare.
Release of Health Records
Print, fill out, and mail, e-mail, or bring to the office for release of records to another specified entity.