New Patients

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

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.

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. We accept cash, check, Visa, MasterCard, Discover, and CareCredit.

Payment is due at time of service.

If you need to cancel your child’s appointment, please give us 48 hours notice whenever possible. If your child misses their first appointment, we may not schedule your child for 6 months, except for emergency treatment. We reserve the right to charge for any missed appointments.

 If you have any questions prior to the appointment, please call us.

New Patient Form