Here's what to expect on your first visit to Green Valley Dental Care:
• We will personally review your dental and medical history with you.
• A comprehensive exam, including appropriate x-rays will be completed.
• Treatment will be prioritized and a plan of care specific to you will be created.
• If appropriate, a separate treatment conference will be provided, giving you a chance to ask questions and review your options.
We deliver the finest care at the most reasonable cost to our patients. Therefore payment is requested at the time of service unless other arrangements have been made in advance. For your convenience we accept personal checks, major credit cards, and CareCredit.
Instructions: Right click (Mac: Ctrl+Click) on the PDF forms below to save them to your computer. Open forms using adobe acrobat. Fill in the form fields and save the PDF. You can then email the completed forms to [email protected]
You can also print off the forms and fill them out by hand to bring with you on the day of your first visit.
In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.
We work hand-in-hand with you to maximize your insurance reimbursement for covered procedures and will submit the claim for you. It is helpful if you bring your insurance card to your visit. This will not only help us file your claim, but will allow us to estimate your coverage with greater reliability. We accept most insurance plans and are contracted with Delta Dental, MetLife, and United Concordia Tri Care.
Severe pain Acute infection Trauma
These are the “Big Three” that constitute the vast majority of dental emergencies: pain, infection and trauma. True dental emergencies will always be addressed at the earliest possible time, nearly always on the same day that you call, even if this means that Dr. Kloek and staff stay after normal business hours. Your safety and health will always be of the highest priority. If an emergency develops for you at a time when the office is not open (evenings, weekends), Dr. Kloek can be reached by calling the after-hours answering machine at 715-635-7888. For the times when Dr. Kloek will not be available by phone (vacations), competent back up coverage will always be arranged. Necessary information, including phone numbers, can be obtained from the after-hours answering machine. You will never be left “high and dry” with a dental emergency.
Why do I need to share my medical history with my dentist? The primary purpose of maintaining current and accurate dental records is to deliver quality patient care and follow-up. It is a blueprint for care and treatment and when it is correct it makes life easier for everyone. During your first dental visit, Dr. Kloek will ask for a thorough medical history, which is included with our patient registration forms. The medical history form will include questions about lifestyle (such as smoking or involvement in high-risk-sports) and family medical history. Many diseases can have significant effects on your mouth and teeth as your oral health is related to your overall health. Diabetes, for instance, can increase the risk of periodontal (gum) disease. The same holds true for any medications you are taking. Some medications cause dry mouth, which can increase the risk of cavities. Other health conditions may require Dr. Kloek to change the type of anesthesia given. Dr. Kloek will also want to make sure that any medications he prescribes don’t interact with medications you already are taking. This history, combined with the results of your initial clinical examination, will help Dr. Kloek assess your immediate dental-care needs and recommend the best treatment approach.
In order to best serve you, it is often helpful to have other information about your past treatment and experiences with previous dental offices. Sometimes questions can be easily answered with a short phone call, letter or (secure) email. It is also helpful to know if you have certain special concerns or fears, or if you have some specific dental goals in mind. Almost all dental offices will, with your authorizations, share pertinent information, including past x-rays. Our form is very short, only one page, so thank you in advance for providing this information to us. It will help us take care of you better!
We also serve the Minong, WI and Shell Lake, WI areas!