Many of the questions you might have can be answered by clicking the links on the left or right side of this home page. Whether it’s easy to understand but detailed definitions on the different forms of sedation and anesthesia, or information on our missed appointments policies, we hope this Web site provides the answers you seek.

Can’t find it on the site? Feel free to call our expert staff who are waiting to give you the best dental experience possible. (913) 341-6767

New Patient Forms

You may access the following forms to assist us with your care. Please print and fill out the desired form, then bring it to your appointment. If we have requested them ahead of time, please send them by fax at (913) 341-8077 or email to office@villagedds.com. This will ensure the best care and allow us to verify your insurance prior to your appointment.

Please contact us with any questions you may have.

Hospital Forms

If you are scheduled for a surgery appointment at Doctor’s Hospital please fill out the Hospital Forms. These must be signed by the guardian, if applicable. Once signed, please send them back to us by fax at (913) 341-8077 or email to office@villagedds.com. These are required prior to the surgery date.

If you are scheduled for a surgery appointment with our anesthesia team, Advanced Specialty Anesthesia, please fill out the ASA Forms. Once filled out in their entirety, please send them back to us by fax or email.

Please contact us with any questions you may have.

Referring Doctor Forms

Thank you for your referral. Please complete the referral page and email or fax it to our office along with any pertinent radiographs. Then give this form to your patient to bring with them to their appointment. We require the referral and x-rays prior to scheduling a consultation.

Please contact us with any questions you may have.

Financing

Payments

Payment is expected at time of service; we offer several payment options:

  • Cash or Personal Check
  • Credit Card – We accept MasterCard, Visa, Discover and American Express.

In addition, financing options are available for the more expensive procedures. Please feel free to discuss these options with our staff.

Insurance

We are happy to bill your insurance provider for any procedure you have in our office. Please bring your insurance card with you to your first visit, or let our staff know if your insurance carrier has changed.

Most often your insurance will not cover the full cost of your dental care. Many plans have a coinsurance, a deductible, and certain other expenses which must be paid by the patient at the time of services.

If you have any questions about your insurance plan or payment options, please call our staff at (913) 341-6767 or e-mail us at info@drfasbinder.com.