New Patient Portal

Patient Rights and Responsibilities

I have read and understood the Patients' Rights and Responsibilities

I have read the Insurance forms and understand: • For your first appointment please remember to bring your Identification card (drivers license) and Insurance information (Policy number, member ID #, claims mailing address). If you DO NOT have this information, we may consider you a "self-pay" patient until we receive all insurance information. • I am responsible to provide the correct insurance information and notify the office if my insurance changes. • I am responsible for any co-payments and any balance my insurance does not cover. • It is my responsibility to confirm that Eve M. Santos DMD participates with my dental insurance plan.

I understand if I have current radiographs from a previous office, it is my responsibility to bring them or have them sent to Santos & von Family Dentistry (Santosandvon@gmail.com) prior to my appointment. If I do not do this, Santos & von Family Dentistry may require new radiographs at my expense.