Health History Form
Please print this form, fill it out and bring it with you to your appointment.
Patient Acknowledgment and Consent Form
We also need you to fill out a Patient Acknowledgment and Consent Form. This form outlines our privacy practices about your patient information. You can print a copy of this form and bring it to your office with you for your appointment.
Dentist Referral Form
You may also have a referral form from your general dentist. Please bring that with you.
When you visit our office, please bring your insurance cards with you and be prepared to pay your co-pay at the time of service. If you’re unsure of your co-pay amount, please contact your insurance company before your appointment. We participate with Delta Dental and, while we don’t participate with other insurance companies, we’ll be happy to file a claim for you. To file an insurance claim for you we will need your social security number, so please be sure to include it when you fill out your Health History Form. If you don’t wish to provide us with your social security number, we do ask you for full payment at the time of service.
Thank you. We look forward to seeing you soon.
– John C. Hall, D.D.S., M.S.
The Michigan Dental Association has recommended that all dental offices close to non-emergent treatment for the next two weeks, starting March 17th. (To open again on Wednesday, April 1st).
During this time, we will be closed to all regular appointments.
WE WILL CONTINUE TO SEE PATIENTS WHO ARE EXPERIENCING PAIN or DENTAL/SURGICAL EMERGENCY. WE WILL BE AVAILABLE TO SCHEDULE EMERGENCY APPOINTMENTS IN OUR TRAVERSE CITY OFFICE ON A LIMITED BASIS.
Our staff is working tirelessly to cancel/reschedule pending appointments.
Please call with any questions/concerns, or to schedule an emergency appointment.
Please stay healthy, observe social distancing. Thanks for your understanding.
- Dr. John Hall
Infection control procedures are actions taken in health care settings to prevent the spread of disease. The Centers for Disease Control and Prevention has recommendations for dental office infection control. Your dentist cares about your safety and works hard to prevent the spread of infection. Before you enter the examining room, all surfaces, such as the dental chair, dental light, drawer handles and countertops, have been cleaned and disinfected. Offices may cover some equipment with protective covers, which are replaced after each patient.
Non-disposable items like the dental tools are cleaned and sterilized between patients. Disposable dental tools and needles are never reused. Infection control precautions also require all dental staff involved in patient care to use appropriate protective equipment such as gloves, masks, gowns and eyewear when needed. After each patient, disposable gloves and masks are thrown away. Before seeing the next patient, everyone on the treatment team washes their hands and put on a new pair of gloves.
Your well-being is important to your dentist and dental staff. That’s why infection control procedures are in place at your dental office. What about the new coronavirus?
It is very understandable to be concerned about the new coronavirus that causes COVID-19. Please know that the precautions your dentist already takes every day to prevent the spread of infection in his or her practice also helps prevent the spread of COVID-19.
If you are ill with flu-like symptoms, you should reschedule your appointment.
If you or someone you are in close contact with have recently traveled to one of the countries with large outbreaks of COVID-19 (China, Italy, Iran, South Korea) or if you have been exposed to someone else who was diagnosed with COVID-19 or who was quarantined as a precaution, wait 14 days until you see your dentist to make sure you have not caught the coronavirus.
If you are healthy, there’s no need to cancel your regularly scheduled dental appointment.
It’s important to know that the majority of people infected with the coronavirus experience flu-like symptoms and then recover. Most people do not develop serious respiratory complications.
Those most at risk of becoming seriously ill are elderly people and those with underlying medical conditions such as diabetes and kidney disease, among others. Children, thus far, have been largely unaffected.
Here are a few things you can do on your own to help keep yourself and those around you healthy:
Visit the CDC’s website for the latest information on COVID-19