Print Patient Forms
- Child Registration Form
- Health History
- Privacy Practices
- Financial Policy
- Records Release Form
Thank you for choosing Kulick Dental for your dental care. Our mission is to deliver rock solid dentistry at reasonable fees.
We are a full-service dental practice providing preventive care, composite fillings, teeth whitening, bonding, mouth guards, dental implants, crowns, bridges, root canals and minor oral surgery.
Please read the information below to ensure a smooth and pleasant initial visit.
Your First Visit
Your initial appointment will consist of a consultation explaining your diagnosis and treatment options. Occasionally, treatment can be done the same day as the consultation. However, a complex medical history or treatment plan will require an evaluation and a second appointment to provide treatment on another day.
Please bring the following items to your first visit:
- New patient forms (download from our web site and return via email: [email protected] or fax: 216-236-6304
- Current x-rays (within the past 12 months)
- A list of your medications
- Dental and medical insurance cards
IMPORTANT: A parent or guardian must accompany all patients under 18 at the consultation visit.
At Kulick Dental, we accept PPO plans from most major insurers. We are in network with: Aetna, Ameritas, Anthem Blue Cross/Blue Shield, Assurant, Cigna, Connection, Delta Dental, Dentegra, DenteMax, GEHA, Guardian, Humana, Liberty Dental, MetLife, Principal, Superior Dental Care and United Concordia insurance plans. Ask our friendly team if we accept your insurance!
We are happy to work with your carrier to maximize your benefit and directly bill them for reimbursement for your treatment. Please be aware of the yearly maximum on your plan.
For out-of-network patients, we offer the financial options listed below.
We offer following payment options:
- Cash, Check, Visa, MasterCard, Discover Card or American Express.
- We offer a 5% courtesy accounting adjustment to patients who pay for treatment plans of $1,500 or more with cash at completion of treatment, but payment in advance is welcome.
- No interest payment plans from Care Credit or the Citi Health Card allow you to pay over time with no interest; convenient, low monthly payment plans are also available; no annual fees or pre-payment penalties.
Monthly billing will gradually be phased out, as our office will no longer extend credit.
For larger, more comprehensive treatment plans of $1,000 or more, a 10% deposit is required to secure your initial treatment appointment.
Appointments missed, cancelled or rescheduled with less than 48 hours notice will incur a fee of $50 for hygiene patients and $100 for the Doctor.
Checks returned for insufficient funds will incur a charge of $30.
We would like to take this opportunity to thank you for choosing our practice for your dental care.