New patient forms & info

As of January 1, 2018 we require ALL patients to complete a patient information form and to read and sign our financial and office policy form. To save time during your next visit we encourage you to download and print the Patient Registration form and the Wakarusa Family Dental Office and Financial Policy form and bring the completed forms with you when you come in. We also will need to see your photo id, and your current insurance card.

If you are new to our office please arrive at least 15 minutes prior to your appointment. Please bring your:

- Dental Insurance ID card or if you don’t have a card – the group number, id number, date of birth, social security number and employer of the insurance subscriber. It is your responsibility to ensure Wakarusa Family Dental, Dr. Jason Edwards, is a contracted provider of your insurance before you come in.


- a Photo ID


- List of current Medications and Dosages (VERY IMPORTANT!)


- Please have your records transferred from your previous dentist to us prior to your first appointment, especially any X-rays taken within the last year. Records and X-rays can be emailed to wakarusafamilydental@gmail.com.


- Print and Fill out the Patient Registration Form – download the pdf


- Printed and signed Office and Financial Policy – download the pdf


- Privacy Policy-you can download our privacy policy for your perusal, or ask to see it when you check in.


If you have been told by your doctor that you need to pre-medicate with an antibiotic before you have your teeth cleaned – please let us know. This is typically the case for any type of total joint replacement. If you are not sure – please contact the surgeon that did the joint replacement surgery. We will require you to take that medication before we will clean your teeth without exception, unless your surgeon tells us it is no longer necessary. This is for YOUR safety. Once your surgeon has called in the original medication, our office will be able to authorize refills going forward.


If you have any questions, please feel free to contact us!

Forms & policies

01 New Patient Form

Please fill out the New Patient Form before your visit.

02 Office & Financial Policy

Please fill out the Office and Financial Policy before your visit.

03 Privacy Policy

Please review our Privacy Policy.

Financial information

As a courtesy to our patients, we file claims with your insurance company for you. It is your responsibility to ensure we are a currently contracted provider with your insurance company, as they change all the time. It is also your responsibility to ensure we have the current, correct insurance information for everyone in your family. Any disputes with your insurance company regarding coverage are your responsibility.

If you do not have insurance, we expect payment at the time of service, unless prior arrangements have been made with our financial office. We accept the following payment methods:

- Cash
- Personal Check
- Money Order
- Master Card
- Visa
- Discover Card
- Flex Spending Account Cards and Health Savings Account cards that have Visa/Mastercard logo on them
- CareCredit health and wellness credit card. Click CareCredit for more information and an application.

For established patients, a payment plan may be an option for major procedures. Please feel free to discuss your financial needs with us before beginning treatment.
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