Patient Forms, Map, and Directions to Mapledale Family Dentistry -Woodbridge Office
Your first visit to Mapledale Family Dentistry, PC involves a few special steps so that we can get to know you. To understand what to expect, please read through this page. You'll find all the practical information you need, such as a map and directions to our office, practice hours, payment policies and more.
Mapledale Family Dentistry, PC
Woodbridge, VA 22193
f. (703) 580-0358
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We know you have many choices when choosing a Dentist in Woodbridge, VA so we have made
requesting an appointment
a simple process via our Web site. If, for any reason, you cannot keep a scheduled appointment, or will be delayed, please call us as soon as possible. Please arrive 15 minutes prior to your appointment time to complete health and insurance information.
Your scheduled appointment time has been reserved specifically for you. We request at least two business days notice (excluding weekends and federal holidays), to cancel or reschedule your appointment. We are aware that unforeseen events sometimes require rescheduling an appointment, and we appreciate your cooperation.
Our office is committed to helping you maximize your insurance benefits. We participate with major PPO insurance plans. Because insurance policies vary, we can only estimate your coverage in good faith but cannot guarantee coverage due to the complexities of insurance contracts. Your estimated patient co-payment must be paid at the time of service. As a courtesy to our patients, we will bill insurance companies for services. If you have any questions, our courteous staff is always available to answer them.
To help us with your insurance filing, please complete the insurance questions on our questionnaire.
Please remember that dental insurance is a benefit for you or your family. If during the course of treatment, your benefits change, the financially responsible party is responsible for the cost of the treatment.
New Patient Referral Program
Refer a new patient, and as a token of our sincere appreciation, we will apply a credit of $50 to your account.
We accept checks, cash or credit cards. We also offer a flexible payment plan. Please see our Financial Coordinator for details. We are happy to file insurance for your reimbursement as long as you are free to choose your own dentist.
CareCredit is here to help you pay for treatments and procedures your insurance doesn’t cover. We offer No Interest* financing or low minimum monthly payment options so you can get what you want when you want it. You can even use CareCredit for your family.
With three simple steps, including an instant approval process, it’s easy to apply for CareCredit. After you’re approved, you’re free to use CareCredit for the services you choose. With CareCredit, the decision’s in your hands to get what you want, when you want it. For more information or to apply online, visit carecredit.com .
Below are the forms our office needs to keep on file for every patient. Feel free to fill them out, print and bring with you to your appointment. In addition, you may also fill out the Patient Registration Form and submit it electronically through a secure server.
Patient Registration Form
Download & Print
Financial Policy Form Download & Print
Privacy Practices Download & Review
Acceptance of Privacy Practices Download & Print
In order to view or print these forms, you will need Adobe Acrobat Reader installed. Click here to download it.