Urbandale Dentist, Contact Us, Practice Information, IA

 www.Showusyoursmile.com 

 

Cosmetic and Family Practice

Dr Bill Skinner

(515)278-2888

Plum Drive Dental - online electronic forms

 
 

 

Please Read the following directions before filling out forms:

For patient forms: Please click on the appropriate link below. There are several pages and each needs to be filled out with as much detail as possible: all questions with an "  *  " sign have to be filled out or you wont be able to continue to the next page (if a question with an " * " does NOT apply to you simply  type in N/A for example: it will ask about insurance, if you dont have insurance, you need to type in the N/A or none). You will be required to sign the form digitially when you come in for your appointment.  All patients that have never filled out the forms electronically, must go through the Click "HERE" for New Patient Forms.  Once that has been filled out, in the future you can then go through as an existing patient (sorry but that is how the software was written!!)

At first you will be asked your first and last name and date of appointment-just put any date in the future unless you really do have an appointment already scheduled, then you should put that date in. You will then be directed to the forms to fill out for the "new patient" even if you are a new patient or an existing patient.   when you come into the office you will be asked to sign the form, give proof of identification, insurance card, and a credit card as we are no longer sending out statements but rather going green by charging your card the difference of the estimated insurance benefit and actual benefit amounts.  This can be set up monthly etc as needed.  Please discuss this with the financial coordinator -Debbie, or the scheduling coordinator-Karen.  thanks


Click "HERE" for New Patient Forms*

 *use this first link for new patients and current patients that have never signed in electronically with the ipad*

 

 

 

 

 

 

 

Click "HERE" for Existing Patient Login**

**after you have signed in as a new patient electronically, from that point forward, on all update forms you will be consideredan existing patient*


 

 

 

 


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Address: 8501 Plum Drive
Urbandale IA 50322
Telephone: 515-278-2888
Fax: 515-253-9774
Email: showusyoursmile@mchsi.com
 
Panora Dental
Address: 611 East Main
Panora IA 50216
Telephone: 641 755 3626
Fax: 641 755 3699
Email: showusyoursmile@mchsi.com