Patient Information

Feel free to download and print the forms below and fill them out prior to your

appointment to save time checking in!

Notice Of Privacy Practices

Hippa Form

Medical History Form

Patient Registration Form

MOUZON FAMILY DENTAL'S MISSION

Mouzon Family Dentistry’s mission is to provide the highest degree of quality dental care in a compassionate, caring, respectful environment. We value building honest relationships with our patients and providing them with individualized dental care that will improve overall health. We will provide our patients with excellent and quality dental care. We are committed to creating an experience that is enjoyable, caring, and positive for each patient by providing the best quality services and relationships.

INSURANCE INFORMATION

At Mouzon Family Dentistry, we make every effort to provide you with the finest care and the most convenient financial options. To accomplish this we work with you to maximize your insurance reimbursement for covered procedures. If you have any problems or questions, please ask our staff. They are well informed and up-to-date. They can be reached by phone at 864-654-5494. Please call if you have any questions or concerns regarding your initial visit. Please bring your insurance information with you to the consultation so that we can expedite reimbursement.

SCHEDULING INFORMATION

Mouzon Family Dentistry is open Monday through Thursday from 8:30 am until 5:30 pm. We will schedule your appointment as promptly as possible. If you have pain or an emergency situation, every attempt will be made to see you that day.

Please call 864-654-5494 with any questions or to schedule an appointment.

BILLING INFORMATION

For your convenience we accept Visa, MasterCard, American Express and Discover. We deliver the finest care at the most reasonable cost to our patients; therefore, payment is due at the time service is rendered unless other arrangements have been made in advance. If you have questions regarding your account, please contact us at 864-654-5494. Many times, a simple telephone call will clear any misunderstandings.

Please remember you are fully responsible for all fees charged by this office regardless of your insurance coverage. We will send you a monthly statement. Most insurance companies will respond within four to six weeks. Please call our office if your statement does not reflect your insurance payment within that time frame. Any remaining balance after your insurance has paid is your responsibility. Your prompt remittance is appreciated. We can make arrangements for a monthly payment plan but this must be done prior to the actual procedure.