Patient Info PDF Print E-mail

We believe that all patients deserve the very best dental care we can provide.  Further, we believe that everyone benefits when definite financial arrangements are clear and agreed on before treatment is started.  We would like to share with you our payment guidelines and methods of payment available.  To make your care as affordable as possible, we offer financing through CareCredit. Please let us know which financial option works best for you.

One Dental Place offers early morning hours and "no-wait" appointments as well as prompt emergency care. We offer credit programs and most insurance is welcome, or you can use your Visa, MasterCard, American Express or Discover card.

Contact our finance/insurance coordinator for more information.


Online Payments

The Smiledash/SR Patient Portal is a free and convenient way for you to access the front desk services of your health-care provider from any internet connection.

  • Review and pay your bills online
  • Check appointments you have scheduled
  • Send secure messaging to your provider
  • View personal images and documents before and after your appointments
  • Change your messaging preferences
  • Set personal reminders for yourself

Get Access and Pay Online


Financing Options


CareCredit is a simple way to consolidate and manage certain out-of-pocket healthcare expenses, because it is a credit card with a revolving line of credit that can be used repeatedly and for any family member. CareCredit offers two basic payment plans to meet an individual’s financial needs:

Under the No Interest Plans for 6, 12, 18 or 24 months, each month you only need to pay the required minimum monthly payment and pay off the remaining balance within the promotional period to avoid interest and pay only the amount financed. Future minimum payments will vary based on amount and timing of payments, interest rate and other charges added to the account.

Extended Payment Plans for 24, 36, 48 or 60 months. These plans carry an interest rate that is more competitive than most bankcards and feature a fixed, monthly payment and a longer term.

Fast, easy and secure!Find out instantly if you are approved and start using your account immediately — even before your card arrives!


Patient Forms

Download the forms below. Then print and bring the completed forms with you to your appointment.

Patient Registration

Medical History

Privacy Notice

Privacy Receipt of Notice

Payment Options

Insurance / Financing


Insurance Accepted

Insurance Accepted

CASH OR CHECK – Receive a 5% bookkeeping courtesy by pre-paying your appointment with cash or check ONLY.  We accept cash, MasterCard, VISA, Discover, American Express to allow you the most convenience in taking care of your account.  We also extend a 3% courtesy when pre-paying your appointment in full with any major credit card.

MONTHLY PAYMENT OPTION - We have made special arrangements with a third party financing company to allow you to complete your dental treatment with a comfortable monthly payment such as CARECREDIT.  One of our team members will be happy to assist you and explain how the program works.

DELTA DENTAL insurance requires you to pay in full for all services.  In turn, Dental Dental will reimburse you directly.  By prioritizing treatment, those patients who do not have dental benefits and are on a tight budget can still complete their dental work by spreading appointments over several months.  We are happy to discuss this option with you.  Please be aware that there are situations where this option may not be available depending on your particular dental conditions and needs.

As a courtesy to you, we will file your insurance for you.  Please keep in mind that your insurance will cover a portion of your treatment.  The remaining portion is your responsibility, and this balance is required to be paid the same day of service.