| Patient Forms |
Please Print & Complete the following forms;
Medical / Dental Insurance Reimbursement
- If interested in insurance reimbursement, please
complete the following form
- Payment for anesthesia services is required in full
on the day of the dental procedure. Insurance
reimbursement is direct to the eligible patient within
roughly thirty (30) days of submission.
History & Physical Consult from Primary Physician
- In most instances, Dr. McCarty requires a
consultation with the patient's primary physician. This
is done in an effort to ensure a patient's safety & also
to provide for confirmation of "medical neccessity"
to utilize anesthesia.
Please provide your medical doctor with the
following form:
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