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At The Dental Place, our team offers reliable, professional, family-friendly dental care in Portland, TX. Our dentist and staff is committed to providing each patient with care specific to their individual needs and wants. We are dedicated to providing you and your family with top-notch general and cosmetic dentistry. We want our patients to feel comfortable about coming to us for their oral health needs, so we ensure our office has a warm and inviting feel and our staff is compassionate in the care they give.
For more information about our dental care or to schedule an appointment, please contact The Dental Place at (361) 643-2522. We look forward to hearing from you!
Patient Forms
All forms must be filled out before we can provide service
Patient Medical Form
This form must be filled out by all new patients. In order to expedite your visit, print and fill in this form, |
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Adult Form
This is a general information form that lets us know a little about you. |
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Child Form
This form allows to get to know your child before our first visit. |
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Privacy Notice
Please read and sign our Notice of Privacy Practices, acknowledging our privacy policy |
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Financial Policy
This form details how insurance plays a part in paying for dental service |
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Medical Release Forms
This form must be filled out if we are to share your or your child’s information with other medical facilities. |
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Preferred Information
This form gives us more information to cater dental services to fit your specific needs. |
We work with these insurances:
• Aetna US Healthcare
• Ameritas Life Insurance Corp
• Assurant Employee Benefits
• Blue Cross/ Blue Shield
• Cigna
• Delta Dental
• Dental Network of America
• GEHA – Connection Dental
• Guardian
• Humana Dental
• MetLife
• Mutual of Omaha
• Principal Insurance
• United Concordia
• United Healthcare
Forms of Payment
All copays are due immediately upon service
All uninsured patients must pay for service in full at time of check out. We accept these forms of payments:
• Cash
• Check
• MasterCard
• Visa
• American Express
• Discover