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MONDAY – THURSDAY:
8 a.m. – 8 p.m.
FRIDAY: 8 a.m. – 4 p.m.
SATURDAY: 8 a.m. – 3 p.m.

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  NEW PATIENT PAPERWORK

Fill out completely online, print, and bring in at your first appointment, or print
and fill out by hand.

We accept most dental insurance. We are preferred providers for the active
duty United Concordia, Blue Cross Blue Shield of Tennessee except the Federal Government Plans, Doral-Tenncare for Children, and we are Premier Providers
for All the Delta Dentals. The following are different types of insurance plans.
Make sure you know which one you have. Also, know your insurance, what it covers, what it doesn't cover, if your have any waiting periods, exclusions, etc.

You will need Adobe Acrobat Reader to view and print the forms.

Forms you will need:

New Patient Info (complete form on-line)

Patient Info Sheet (signature is required)

Financial Agreement (signature is required)

Medical History (signature is required)

HIPAA Privacy Act (signature is required)

HIPAA Privacy Acknowledgment

Please click here to schedule an appointment


 
     
     
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Clarksville Dental Center 1301 Peachers Mill Road Clarksville, TN 37042
Phone: 931-572-9152 Fax: 931-572-9155 cdc@clarksvilledent.com
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