NEW PATIENT REGISTRATION --

    Address

    Telephone

    INSURANCE INFORMATION --

    Relationship to Subscriber:

    SelfSpouseChildOther

    * Please present your insurance card to be photocopied for our records.

    RESPONSIBLE PARTY (if patient is a minor or different from patient listed above) --

    Address

    Telephone

    EMERGENCY CONTACT --

    AUTHORIZATION --

    I consent to the diagnostic procedures and dental treatment performed by my dentist, and to the release of information concerning my (or my child’s) health care, advice, and treatment to another dentist, or for evaluation and administering any claims for insurance benefits. I consent to the direct payment of my insurance benefits to the practice and understand my insurance may pay less than the actual bill for services and that I am responsible for any services not paid or covered.

    ELECTRONIC COMMUNICATIONS --

    I consent to receiving HIPAA-compliant electronic communications, such as email and text messages regarding treatment, payment, etc. I understand there is no obligation to receive these electronic communications.


    Real Patient Experiences

    We care deeply about helping patients to achieve better oral-health and self-confidence. See what real patients have to say about their experiences with Vital Dental Care.

    We continue to use this place because they simply do great work and the prices are affordable compared to most others around. Need a dentist for your self or your child this is the place to go.

    Lulu L.

    I’m so glad to be a patient of This magnificent dental office. Fantastic team and Doctors . Make you feel like family

    Marysol S.

    It is the most professional and clean place that I have been. The workers are very nice and helpful. Once you walk into the office you are greeted with a smile and they are very pleasant

    Veronica H.

    I went to Vital Dental with a broken tooth with an exposed nerve. Had no insurance so I was nervous. Was in extreme pain and was seen as soon as possible. The staff helped me to cope with the pain and then Dr Williams and his assistant worked magic to stop the pain and removed the broken tooth. The price was the cheapest in town for this fantastic service. I recommend this place 10000%

    Kerry F.

    I needed emergency dental care and had viewed many websites before finding this dental office. The staff are professional, efficient and friendly! I was intending on them being a one time appt but have already switched Dentists after 30 yrs of same Dentist. The ladies are knowledgeable, very helpful and caring! I am very comfortable with the Dentist and staff and recommend this office!

    Wanda D.

    It was a pleasure visiting Vital Dental. Had been there before and decided not to go back but found that there is new staff and just the sweetest and very professional group of people. I feel very confident about my care now because of the reassurance I feel. Just the way my plan of action was explained I feel I have gone to the right place. Thank you.

    Sharon B