New Patient Registration

Patient Information

General & Cosmetic Dentistry Surprise, AZ

Thank you for scheduling your next dental visit with us. Please prepare your new patient intake forms before your first visit.

New Patient Intake Form

This will allow you time to fill them out at your convenience and it saves you time when you come in. We look forward to seeing you soon.

3 Options for a First Visit With, Dr. Matthews

The “Comprehensive Evaluation”

This Exam is great for someone who is not currently having regular dental checkups or is unhappy with their mouth and wants to improve aesthetics and overall function.  This exam takes a comprehensive look at every tooth and area in the mouth to find all the problems and issues that may be present and possible options to resolve them.   For this appointment usually the cleaning is scheduled for another day.

This initial appointment will be about 45 minutes to an hour and will consist of the following:

  1. Full Set of X-rays
  2. Periodontal Assessment
  3. Intraoral Photos
  4. A “Tour of your Mouth”
  5. Treatment Plan Recommendations and Options

The “Regular Check Up”

For those who have regular dental checkups, are not in pain and don’t perceive to have any apparent issues with their teeth.  If you are not concerned with improving your smile and pretty much want to continue with a healthy mouth.  This appointment will also include the cleaning.

This initial appointment will be about  1 hour and will consist of the following:

  1. X-rays (either a full set if needed or just bitewings if you already have a current full set.)
  2. Periodontal Assessment
  3. Oral Cancer Screening
  4. Cleaning by a hygienist
  5. Exam and treatment recommendations if needed.

The “Emergency Exam”

This exam is for the person who just broke a tooth or has an emergency and only wants the emergency issue addressed.  Dr. Matthews will only look at the specified area where the patient is having the emergency and address what to do to resolve the emergency.  The time needed for this appointment completely depends on the emergency and if treatment can be rendered at the time of the exam. If will consist of the following:

  1. Problem focused exam by the dentist
  2. 1 or more x-rays, only x-rays that are needed to help diagnose the issue
  3. Treatment to resolve the “emergency” if possible

Please note that not all new patients can have their cleanings the same day. It will depend on your oral health status and treatment recommendations.

IMPORTANT: All patients under 18 must be accompanied by a parent or guardian during their visit. Please alert the office if you have a medical condition that may be of concern (i.e. diabetes, high blood pressure, artificial heart valves and joints, rheumatic fever, etc.) or if you are on any medication (i.e. heart medications, aspirin, anticoagulant therapy, etc.); a list is helpful.

X-RAYS

If you have had x-rays taken recently, please contact your previous dentist and have them email them to us at info@surprisefamilydentist.com.

SCHEDULE AN APPOINTMENT

OFFICE HOURS

We will schedule your appointment as promptly as possible. If you have pain or an emergency situation, every attempt will be made to see you that day.

The office of Dr. Robert J. Matthews, DMD is open:

Monday, Tuesday, Wednesday andThursday 9:00 a.m. to 5:00 p.m.
Closed: Friday – Sunday

We try our best to stay on schedule to minimize your waiting. Due to the fact Dr. Matthews provides many types of dental services, various circumstances may lengthen the time allocated for a procedure. Emergency cases can also arise and cause delays. We appreciate your understanding and patience.

Please call us at 623-972-1200 with any questions or to schedule an appointment.

FINANCIAL POLICY

PATIENT BILLING

For your convenience we accept Visa, Mastercard, American Express, and Discover, and financing for the entire treatment plan through CareCredit, which is a third party specializing in financing health care expenses.

CareCredit: Apply online at www.carecredit.com

Printable Financial Policy

We deliver the finest care at the most reasonable cost to our patients, therefore payment is due at the time service is rendered unless other arrangements have been made in advance. If you have questions regarding your account, please contact us at 623-972-1200. Many times, a simple telephone call will clear any misunderstandings.

Please remember you are fully responsible for all fees charged by this office regardless of your insurance coverage.

We will send you a monthly statement. Most insurance companies will respond within four to six weeks. Please call our office if your statement does not reflect your insurance payment within that time frame. Any remaining balance after your insurance has paid is your responsibility. Your prompt remittance is appreciated. We can make arrangements for a monthly payment plan but this must be done prior to the actual procedure.

DENTAL INSURANCE INFORMATION

Our practice is in-network with most PPO dental insurances. Preventative services are usually covered at 80-100%. Major restorative procedures such as crowns, bridges, full and partial dentures are usually covered at 50%.

Most cosmetic procedures such as veneers, whitening, and bonding are not covered by dental insurances, and will be patient’s responsibility. However, our fees for these procedures are very reasonable comparing to many other dental practices thanks to our philosophy of maintaining a small private practice.

DENTAL INSURANCE PLANS WE WORK WITH:

  • Delta Dental
  • Blue Cross Blue Shield
  • Guardian
  • Metlife
  • Ameritas
  • Cigna Dental
  • Principal
  • Aetna
  • United Healthcare PPO
  • United Concordia
  • Maverest Dental
  • SecureCare
  • Most Dental PPO’s are accepted – Please call us to verify if we take your plan, We currently are not accepting any HMO plans.

GOLD PLUS DENTAL/SAVINGS PLAN

Your Surprise Family Dentist wants you to have the best overall health possible. To continue to provide you with the best oral care, we now have a Savings Plan for those of you that no longer have insurance or have never had dental insurance.

The Gold Plus Dental Savings Plan is designed to provide affordability and greater access to quality dental care. (Please note this is NOT dental insurance)

With your Gold Plus Dental Saving Plan there are:

  • No Claim forms
  • No yearly maximums
  • No annual Deductibles
  • No pre-authorization requirements
  • Pay less for major and minor procedures

Benefits Include:

  • Two FREE Regular Cleanings per year
  • Free periodic exams if needed
  • Access to the Gold Plus Plan fee schedule, which provides discounts off the normal debtal fees of up to 40%. Discount varies by procedure.

Some limitations may apply
*$199/year per calendar year January through December

Printable Gold Plus Dental Plan

Questions? Please feel free to call us at our Surprise Office Phone Number 623-972-1200 to speak to a staff member.