New Patients

Patient Forms

To expedite your appointment, we invite you to complete our new patient forms at home. Just remember to bring the completed forms to your visit, and send the records request form to your previous dentist so any current X-rays can be sent to us prior to your appointment at Woodbury Dental Care. We look forward to meeting you.

Patient Registration Form

Health History Form

Notice of Privacy Practice

X-Ray Request Form

Financial Information

At Woodbury Dental Care, we accept all dental insurance plans that allow you to choose your dentist. We are also contracted with several insurance plans. Please call your insurance company to see if we are in network for your plan.

Methods of payment include; cash, check, Visa, MasterCard, Discover, AmericanExpress, and CareCredit: a third-party financing program that offers low- and no-interest financing plans.


For those without access to dental insurance through their employer or are otherwise uninsured Woodbury Dental Care offers a Private Plan. This plan allows you to have the quality dental care you want and deserve without deductibles, pre-authorizations, coverage denials and yearly maximums. More information on cost and savings listed below.

We also offer a 5% discount to those who pay on the day of their service and 10% discount to senior citizens who pay day of service, with no insurance or active WDC plan.

Woodbury Dental Care Private Plan

100% SAVINGS ON: Comprehensive and Periodic Exams, X-rays (excludes CT scan), Routine Recare and Perodontal Mantenance cleanings, Sealants and Fluoride Treatments (all up to 2x/year) Example: typical annual fees for two recare visits including 2 cleanings, exams, and X-rays = $506

15% SAVINGS ON: Fillings, Roots Canals, Oral Surgery, Periodontics (Periodontal Scaling and Root Planing), CT Scan, Crowns and build-ups, Bridges, Veneers, Implants, Dentures and Partials (Excludes Orthodontics and Products)

Annual Benefit Costs

  • Single $349
  • Dual $629
  • Family of 3 $869
  • Family of 4 or more $999

Children can enroll up until the age of 18 on your family plan. If your adult child is attending college, then the plan is extended to the age of 23.

You will not receive a membership card. Your effective date will be the date of full payment of your chosen plan. This is NON - REFUNDABLE plan will be effective for 1 year and is renewable.

Patient's portion of the bill is due at the time of treatment. No payment plans or arrangements will be extended.

The dental plan cannot be used with any existing insurance plan or worker's compensation or with any other discount of promotion.

The dental plan is honored only at Woodbury Dental Care. It cannot be used at any other offices or any office that we may refer you to.

Our Office Policy Regarding Dental Insurance

If we have received all of your insurance information on the day of the appointment, we will be happy to file your claim for you. By law your insurance company is required to pay each claim within 30 days of receipt. We file all insurance electronically, so your insurance company will receive each claim within days of the treatment. You are responsible for any balance on your account after 60 days, whether insurance has paid or not. If you have not paid your balance within 60 days a billing fee of 1.5% will be added to your account each month until paid. We will be glad to send a refund to you if or when your insurance pays us.

PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients. We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim. We can only assist you in estimating your portion of the cost of treatment. We at no time guarantee what your insurance will or will not do with each claim.

You should make yourself familiar with your insurance benefits, as we may collect from you a partial payment of the estimated amount insurance is not expected to pay.


Dental insurance is meant to be an aid in receiving dental care. Many patients think that their insurance pays 90%-100% of all dental fees. This is not true! Most plans only pay between 50%-80% of the average total fee. Some pay more, some pay less. The percentage paid is usually determined by how much you or your employer has paid for coverage, or the type of contract your employer has set up with the insurance company.


You may have noticed that sometimes your dental insurer reimburses you or the dentist at a lower rate than the dentist’s actual fee. Frequently, insurance companies state that the reimbursement was reduced because your dentist’s fee has exceeded the usual, customary, or reasonable fee (“UCR”) used by the company.

A statement such as this gives the impression that any fee greater than the amount paid by the insurance company is unreasonable, or well above what most dentists in the area charge for a certain service. This can be very misleading and simply is not accurate.

Insurance companies set their own schedules, and each company uses a different set of fees they consider allowable. These allowable fees may vary widely, because each company collects fee information from claims in processes. The insurance company then takes this data and arbitrarily chooses a level they call the “allowable” UCR fee. Frequently, this data can be three to five years old and these “allowable” fees are set by the insurance company so they can make a net 20%-30% profit.

Unfortunately, insurance companies imply that your dentist is “overcharging”, rather than say that they are “underpaying”, or that their benefits are low. In general, the less expensive insurance policy will use a lower usual, customary, or reasonable (UCR) figure.


When estimating dental benefits, deductibles and percentages must be considered. To illustrate, assume the fee for the service in $150.00. Assuming that the insurance company allows $150.00 as its usual and customary (UCR) fee, we figure out what benefits will be paid. First a deductible (paid by you), on average $50, is subtracted, leaving $100.00. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of $100.00, or $80.00. Out of a $150.00 fee they will pay an estimated $80.00 leaving a remaining portion of $70.00 (to be paid by the patient). Of course, if the UCR is less than $150.00 or your plan pays only 50% then the insurance benefits will also be significantly less.

MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.