"Ignore your teeth, they'll go away".

    "You don't have to brush all your teeth, just the one's you want to keep".

 

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          Dr. Michael Robinson

                 Fellow in Academy of General Dentistry

                           McIntosh, Alabama  

            
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Alabama Dental Association

 

 

 

  "REDNECK PACIFIER"

General Patient Information

Mailing address, physical address, telephone numbers, etc.

Health History

A detailed health history necessary for diagnosis and treatment planning.

Authorization and Release

Authorization to release your dental information for the purposes of filing dental insurance claims on your behalf.

Financial Responsibility

Our financial responsibility document for your review.  The person responsible for the account will sign this agreement at our office.

Insurance Information

Information necessary for the filing of claims in your behalf to your dental insurance carrier or other third-party payor.

 

 

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No representation is made that the quality of dental services to be provided is superior to the quality of services provided by other dentists.

Send mail to drmike@docktormike.com with questions or comments about this web site.
Copyright © 2002 R. Michael Robinson D.M.D.
Last modified: November 17, 2003