Forms & Policies
New Patient Forms
We have provided the forms below for you to download in advance before your child’s first visit to Kids Smile. Please print the forms , fill them out and bring them to your child’s first visit. We will be happy to answer any questions at 760-529-9820, or you can also send us a message online.
Thank you for choosing Kid’s Smile for your child’s dental care.
- New Patient Questionaire (PDF - 580KB)
- Notice of Privacy Practices (PDF - 21.5KB)
- Acknowledgment of Receipt of Notice of Privacy Practices (PDF - 20KB)
- Dental Materials Fact (PDF - 108KB)
Download Adobe Reader to see the PDF forms.
To the Parents
We would like to welcome you and your children to Kids Smile Pediatric Dentistry. A pediatric dentist is specially trained for two to three years beyond dental school just to address the specific dental needs of children. Because children’s teeth are different from adults’, children usually need a different approach to treatment than adults do. We strive to meet the standard of care laid out in the guidelines by the American Dental Association and the American Academy of Pediatric Dentistry.
How are Appointments Scheduled?
We are eager to work with you on scheduling a convenient time for you and your child. We recommend that pre-school aged children come in the morning when they are fresher.
Rescheduled and failed appointments
We require at least 24 hours advance notice if you have to cancel an appointment. If you have 3 late-canceled or a missed appointments, you may be subject to dismissal from our clinic.
If your child has an emergency such as oral trauma, uncontrolled bleeding, pain, or swelling, please call the office at 760-529-9820. If it is after hours the on-call doctor will return your call.
Payment for professional services is due at the time dental treatment is provided.
We accept most insurance, as well as cash, personal checks, and major credit cards. We have also been able to arrange special third party payment plans. Please ask us about this option. We are pleased to accept CareCredit.
Our Office Policy Regarding Dental Insurance
We require all your insurance information on the day of the appointment in order to file your insurance claim. Please be familiar with your insurance benefits as we will ask for payment from you of the estimated amount insurance is not expected to pay. We can only assist you in estimating your portion of the cost of treatment and cannot guarantee what your insurance will or will not cover with each claim. We will do our best to help you with as much information as possible.
— Thank you.