Downloadable New Patient PDF Forms
-Patient Registration & Medical History (English)
-No Show/Late Cancellation Policy (English)
-Privacy Practices (English)
-Acknowledgement of Receipt of Privacy Practices Notice (English)
-Registro del Paciente E Historia Médica
-Aviso Sobre La Privacidad En La Práctica
-Poliza De No Presentarse/Tarde Cancelacion
-Acuse de Recibo del Aviso de Prácticas de Privacidad
Insurance and Financing
Dr. Molar Family Dentistry can provide you with a cost estimate for any treatments or services we perform.
Payment is due at the time of treatment, unless other arrangements are made.
You are responsible for any co-pays, out-of-pocket or any unreimbursed expenses.
Dr. Molar Family Dentistry currently accepts many major insurance plans, and will submit your claim to your insurance company for them to determine the reimbursement.
Current insurance plans accepted:
-Aetna
-Ameritas
-Anthem
-Assurant
-Cigna:
-Delta Dental
-GEHA
-Guardian
-Humana
-Metlife
-Potawatomi
-Principle
-UMR
-United Concordia
-United Health Care
*Not accepting Medicare or Medicaid patients at this time.
**It is the patient’s responsibility to make sure coverage is in effect and your Dr. Molar Family dentist is in your plan before your first appointment.
Payment Options:
We accept several payment methods::
-Cash
-Check

-NEW!, you can now pay your balance online. CLICK HERE
-CareCredit. Apply for a pre-approved, no interest, monthly payment plan. CLICK HERE
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