New Patients

Thank you for trusting Jackson Pediatric Dentistry for your dental needs! At your child’s first appointment, our doctors will complete a dental exam, take any necessary x-rays, and consult with you regarding any treatment needs your child may have. We will then schedule a follow-up appointment, if treatment is needed.

Please arrive 30 minutes before the scheduled appointment time for the first visit. This allows us to confirm insurance information and health history. Our office participates with Delta Dental, Healthy Kids Dental, and MiChild; other carriers will be billed for you. If necessary, we will set up a treatment plan to help estimate the cost of dental care for your child. We accept cash, check, Visa, MasterCard, Discover, and CareCredit. Payment is due at time of service.

Upon registering your child over the phone with one of our receptionists, we will mail paperwork to the address given; this paperwork must only be filled out by a parent or legal guardian. (If you are the child’s legal guardian, you must bring legal documentation on your first visit.) Please complete this paperwork and bring it to your child’s first appointment. If you have misplaced the paperwork mailed to you, you may download it below.

If you need to cancel an appointment, please give us 48 hours notice whenever possible. Missed and broken appointments will delay your child’s treatment. We reserve the right to charge for any broken appointments.

If you have any questions prior to the appointment, please don’t hesitate to call our office!

New Patient Form