PATIENT CENTER

New Patient Center

You're In Excellent Hands

We make sure all our patients feel welcome, safe, and taken care of. During your first visit, we will review your dental and medical history. For diagnosis, we will examine your teeth and take X-rays of your mouth. We then proceed with a thorough dental cleaning. Finally, we will explain any issues and help you choose a dentist for your follow-up treatment.

For a shorter time in the waiting room, please fill out our New Patient Forms and bring them with you on the day of your visit.

Insurance:

Dental Forms — Colorado Springs, CO — Smile Heart Dental Hygiene

At Smile Heart Dental Hygiene, we will assist you in submitting your dental claims to insurance. However, it is the patient's responsibility to ensure all financial requirements are met before service.

Don't have insurance? No problem! We offer Dental Wellness Plans for people without insurance or looking for options outside a typical dental insurance program.

You're In Excellent Hands

For a shorter time in the waiting room, please fill out our New Patient Forms and bring them with you on the day of your visit.

Insurance:

Don't have insurance? No problem! We offer Dental Wellness Plans for people without insurance or looking for options outside a typical dental insurance program.

Patient Forms

New Patient Forms

For your convenience, our patient forms are made available online to print and fill out at home. Please bring them with you on the day of your appointment to save time in our office. If you have questions, please contact us we will be happy to assist you.

Patient Registration Form

Health History Form

HIPAA & Financial Consent Form

Existing Patients

If you are an existing patient and would like us to update our records with new information, please download and fill out the following form.

Patient Information Form

Note: All files are in PDF format. If you do not have Adobe® Reader® on your computer, you can download it for free by clicking here.

Insurance

Every dental insurance plan is different and their coverage can vary widely. We aim to help you understand your dental benefits while also receiving the maximum services with which are you eligible.

We can file your dental insurance claims, provide you information about any services not covered, and notify you of any out-of-pocket costs associated with your appointment.

We are currently contracted with Delta Dental of Colorado, however, we can submit claims to any insurance provider on your behalf.

Don’t Have Dental Insurance?

No problem, Smile Heart Dental Hygiene offers Dental Wellness Plans to help those without dental insurance receive the benefits of regular dental services.

Dental Wellness Plans

Don’t have insurance? No problem! We offer dental wellness plans for people without insurance or for those looking for options outside a typical dental insurance program. Our plans will save you time and money because there are no waiting periods, no annual maximums, no claims to file, and reduced dental fees.

Child Plan $20/month**

Child Plan: 12-years-old and younger

Professional dental cleanings (2/year)
Comprehensive exam (1/year)
Needed x-rays*
Fluoride treatment (2/year)
10% off all other treatments (some exclusions may apply)

Adult Plan $27/month**

Adult Plan: 13-years-old and older

Professional dental cleanings (2/year)
Comprehensive exam (1/year)
Needed x-rays*
10% off all other treatments (some exclusions may apply)

For patients with regular cleanings and the absence of periodontal disease.

Perio Plan $50/month**

Perio Plan: Members with Periodontal Disease

Perio maintenance cleanings (3-4/year)
Comprehensive exam (1/year)
Needed x-rays*
20% off initial periodontal therapy
10% off all other treatments (some exclusions may apply)

For patients enrolled in active periodontal maintenance due to prior treatment for periodontal (gum) disease.

*Needed x-rays are determined by the Registered Dental Hygienist at the time of the exam.

**A Lifetime Activation fee of $49 is required to join. This fee includes your first month’s Wellness Plan dues.

Legal & Disclaimers: Dental Wellness Plans are not insurance but a payment arrangement provided by Smile Heart Dental Hygiene, LLC for services rendered. Dental Wellness Plans are not transferable to other dental offices. A lapse of 28-days in dues will require a reactivation fee of six month’s due. Wellness Plan discounts may not be combined with insurance or any other offers or discounts. It is solely the patient’s responsibility to schedule and keep their appointments. No refunds will be provided for dues paid under any circumstances, including failure to schedule and maintain appointments. A patient’s monthly agreement is with the legal entity of Smile Heart Dental Hygiene, LLC. Monthly dues and fees for hygiene services may change at any time without notice.

Call us today at 719-755-0155 to enroll in a plan that is right for you!