Patient Intake Form

Brightside Dental Studio offers direct billing to insurance companies as a convenience to our patients.

Dental insurance is intended to assist you with the payment of your dental care, however, there may be procedures that are not covered. As the insurance policy holder you are responsible to be aware of your coverage. Each plan varies significantly and we cannot keep track of everyone’s differing benefits. Please ensure that you are aware of all policy changes, yearly limits, deductibles, recall dates, and reset dates pertaining to your own policy for yourself, as well as any covered family members.

Brightside Dental Studio is not responsible for procedures that are not covered by your insurance, so if you have any concerns regarding this, please inquire with one of our staff members to see if a pre-determination is needed prior to your scheduled appointment.