{"id":31,"date":"2015-10-23T12:56:29","date_gmt":"2015-10-23T17:56:29","guid":{"rendered":"http:\/\/thomashpyritz.wpengine.com\/?page_id=31"},"modified":"2020-11-19T15:15:24","modified_gmt":"2020-11-19T21:15:24","slug":"patient-forms","status":"publish","type":"page","link":"https:\/\/pensacoladentalcenter.com\/?page_id=31","title":{"rendered":"Patient Forms"},"content":{"rendered":"<div class=\"io-post-marker\" style=\"display:none\"><\/div><h2>Medical Forms and Information<\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-32\" src=\"http:\/\/thomashpyritz.wpengine.com\/wp-content\/uploads\/2015\/10\/PatientHistoryClipboard.jpg\" alt=\"PatientHistoryClipboard\" width=\"265\" height=\"211\" srcset=\"https:\/\/pensacoladentalcenter.com\/wp-content\/uploads\/2015\/10\/PatientHistoryClipboard.jpg 265w, https:\/\/pensacoladentalcenter.com\/wp-content\/uploads\/2015\/10\/PatientHistoryClipboard-100x80.jpg 100w, https:\/\/pensacoladentalcenter.com\/wp-content\/uploads\/2015\/10\/PatientHistoryClipboard-150x119.jpg 150w, https:\/\/pensacoladentalcenter.com\/wp-content\/uploads\/2015\/10\/PatientHistoryClipboard-200x159.jpg 200w\" sizes=\"auto, (max-width: 265px) 100vw, 265px\" \/><\/p>\n<p>To save you time at your initial visit, please print the forms listed below, complete them, and either:<\/p>\n<p>\u2022 bring with you to your appointment<\/p>\n<p>-or-<\/p>\n<p>\u2022 scan the completed forms and email to info@pensacoladentalcenter.com<\/p>\n<p>\u00a0<\/p>\n<p>At your first visit every year, we will need your insurance card and photo ID for our records.<\/p>\n<p>If you are coming in for a comprehensive exam and wish for us to accept assignment of dental insurance benefits (where your payment will be copays, deductibles, etc), please\u00a0call us at 850-478-2998. Please have your insurance card and photo ID in hand when you call.<br \/>Your insurance information will be\u00a0needed a few days prior to\u00a0your appointment date so that we can verify eligibility and benefits.<\/p>\n<p>If your first visit is a problem focused visit, you may bring your insurance information with you. We will be happy to file the paperwork to have your insurance benefits sent to you. Please note we DO NOT accept assignment of dental insurance benefits until you become a comprehensive care patient. As a result, we you are expected to pay IN FULL for your problem focused visit.<\/p>\n<p><span style=\"text-decoration: underline;\"><strong>Patient Forms:<\/strong><\/span><b><br \/><a href=\"http:\/\/thomashpyritz.wpengine.com\/wp-content\/uploads\/2020\/11\/2020-New-Medical-History.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Medical History<\/a><br \/><\/b><\/p>\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Medical Forms and Information To save you time at your initial visit, please print the forms listed below, complete them, and either: \u2022 bring with you to your appointment -or- \u2022 scan the completed forms and email to info@pensacoladentalcenter.com \u00a0<span class=\"ellipsis\">&hellip;<\/span><\/p>\n<div class=\"read-more\"><a href=\"https:\/\/pensacoladentalcenter.com\/?page_id=31\">Read more &#8250;<\/a><\/div>\n<p><!-- end of .read-more --><\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":5,"comment_status":"closed","ping_status":"closed","template":"full-width-page.php","meta":{"footnotes":""},"class_list":["post-31","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/pensacoladentalcenter.com\/index.php?rest_route=\/wp\/v2\/pages\/31","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pensacoladentalcenter.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/pensacoladentalcenter.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/pensacoladentalcenter.com\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/pensacoladentalcenter.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=31"}],"version-history":[{"count":0,"href":"https:\/\/pensacoladentalcenter.com\/index.php?rest_route=\/wp\/v2\/pages\/31\/revisions"}],"wp:attachment":[{"href":"https:\/\/pensacoladentalcenter.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=31"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}