My Fairfax Dental
Family, Cosmetic and Implant Dentist
3930 Pender Drive. Suite 220. Fairfax. VA 22030. (571-969-3368 / 571-9-MYDENTIST)

Dental Patient Information

Patient Information

Click for Patient Registration Forms

We accept all PPO insurances (Call us on 571-969-3368 to confirm for your plan, if we don't carry it, we will try to add it). We will also submit claims on your behalf, saving you the time and hassle.

At My Fairfax Dental, we can check your benefits electronically and tell you upfront what your insurance plan will pay for as well as offering options for payment of any balance that remains.

We also accept Medicaid and Smiles for children.

Please contact us with any questions you have about insurances and coverage; we will be happy to help.


My First Visit to My Fairfax Dental (click to read more)

All new patients can expect a very comprehensive oral exam, knowing you are getting the best dental care in Fairfax.

  • Dental Exam and Cleaning
  • Digital X-Rays
  • Oral Cancer Screening
  • Periodontal / Gum Evaluation

To learn more about what to expect on your first visit. Click Here..

New Patient Information and Forms (click to read more)

Our office is fully digital and we use electronic registration forms which can be filled out on your computer, phone or tablet.

Please click here to fill out the registration forms before your appointment

Our electronic forms are automatically sent out for appointments in advance of an appointment, you simply click the link in the email to register and complete the forms on your own time. We are looking forward to seeing you soon. Thank you!

 

HIPAA (click to read more)

Our HIPAA Privacy Notice describes our policies concerning health information and our commitment to protect the privacy of our patients.

HIPAA Notice of Privacy Practices

Financial Arrangements (click to read more)

At My Fairfax Dental, Our goal is to provide the highest quality of dental care possible and to have clear communication of our financial policy.


ALL ACCOUNTS ARE DUE AND PAYABLE AT TIME OF SERVICE. If a procedure requires multiple appointments, payment is required in full at the first appointment.


Payment options:

  • Cash

  • Check* (Only for established patients)

  • Debit card

  • Credit card (MasterCard, Visa and Amex)


*Checks are not accepted for new patients and emergency patients.


Patient with insurance:

As a courtesy to you, our office will submit claims to your insurance provider. If for any reason the claims go unpaid you will be responsible for all charges. The patient is responsible for the estimated non-covered portion, procedures and/or deductibles at the time of the service.


Parents not accompanying their child to an appointment must make prior arrangements for payment (cash or credit card authorization).


Parents accompanying their children are financially responsible for payment.

Patient Privacy Policy (click to read more)

At My Fairfax Dental, we value our patients and are very careful in the way we safegaurd personal health information. Our HIPAA Privacy Notice describes our policies concerning health information and our commitment to protect the privacy of our patients.

Cancellation Policy (click to read more)

Please note that once you have an appointment, we make every effort to reserve that time especially for you. Should you, for any reason, find that you must cancel or reschedule your appointment, we ask that you give us at least 48 hours notice in order to avoid a cancellation fee.

Insurance FAQs (click to read more)

We accept almost all PPO insurances (Call us on 571-969-3368 to confirm for your plan, if we don't carry it, we will try to add it).

We do not accept HMO plans unfortunately.

We will also submit claims on your behalf, saving you the time and hassle.

Some of the dental PPO insurances we accept include:

  • Cigna
  • Guardian
  • Delta Dental
  • Aetna
  • United Concordia
  • GEHA
  • Anthem
  • Dominion
  • The Principal
  • DentaQuest
  • Medicaid
  • Smiles for Children
  • Many others . . .

Dental health and treatment is important. Any patient can go to any dentist whether or not they have dental insurance. There is no insurance plan that will cover all dental expenses. Most insurance companies pay a percentage of the charge. It is always the patient's responsibility to pay any deductible amount, co-insurance, or any other balance not paid by their insurance company.

Patient's Without Insurance (click to read more)

We offer an in-house dental membership that offers a discount on our office fees and provides for 2 regular checkup and exams also. Call our office if you have no insurance and we will help you get the treatment you need.

Dental health and treatment is important. Any patient can go to any dentist whether or not they have dental insurance. There is no insurance plan that will cover all dental expenses.

We also provide dental care for patients without dental insurance and offer low or no interest financing through Care Credit.

We do our utmost to help patients without insurance and offer assistance and discount's for upfront payments.