New Patient Registration

New Patient Registration

6029 Beltline Road, Suite 120, Dallas, TX 75254 | Phone: 972-503-7200 Fax: 972-503-7276
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Radiograph Policy in Accordance with State Practice Guidelines

In accordance with the guideline of the Texas Occupations Code for Dentistry and by following the Standard of Care for our patients, Dr. Buskin. Dr. Castellon, and Dr. Jackson will complete a yearly exam on each patient as they are seen for their dental cleanings. At each exam we evaluate the mouth for:
- Tooth decay, fractures, or areas of enamel demineralization/weakening
- Current integrity of existing restorations and need for replacement
- Pathologies of the oral tissues and abnormal lesions
- Existing bone, bone loss, and joint problems
For our doctors to provide this standard of care and complete a thorough yearly exam, we will need to have radiographs of the oral cavity to help us ensure no potential issues are left undiagnosed. The doctors will have only a limited understanding of the current condition of your mouth by directly viewing your teeth during an exam, so updated radiographs are imperative to your overall health and diagnosis. At our office, we share your concerns about radiation which is why we follow strict standards when taking radiographs including:
- Utilization of lead vests for your protection
- Use of digital radiography, which reduces normal exposure by half
- Avoiding radiation to expectant mothers unless there is a dental emergency
- Only taking x-rays on a yearly basis (unless otherwise needed) and taking a panoramic series or Full Mouth Series every 3-5 years
If any of our doctors have instructed their staff to take a radiograph, they believe that it is necessary for proper dental care.

By signing below, you are agreeing to our office policy regarding taking radiographs.
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Written Financial Policy

We appreciate you choosing Dallas Prosthodontics for your dental care. Our primary mission is to deliver the best and most comprehensive dental care available. An important part of that mission is making the cost of care as easy and manageable for our patients by offering several payment options:
- Cash, Check, Visa, Mastercard, American Express or Discover
  We offer a 5% discount to those paying by cash or check which will be applied at the end of your treatment. This is not to be combined with any additional discount.
- No interest payment plans from Care Credit
  Care Credit allows you to pay over time, with no added interest if paid within a year. You can make convenient, low monthly payments with no annual fees or early-payout penalties.
Dr. Buskin, Dr. Castellon, and Dr. Jackson require payment prior to the completion of your treatment. If you choose to discontinue care before your treatment is complete, your refund will be determined upon review of your case. A payment plan can be discussed with your dentist and arrangements will be made on a case-by-case basis.

For patients with dental insurance:

Most insurance companies provide some benefits for our patients, and we will do everything we can to maximize those benefits. With that being said, we do not work for any insurance company. Our office is out of network with all insurance providers. Please understand that the fees we charge and the treatment(s) we are going to recommend are specifically designed for your individual needs and will never be based on your insurance coverage.

Missed appointment/cancelled appointment within 24 hours:

We require a minimum of 24 hour notice to cancel/reschedule an appointment. If an appointment is cancelled within 24 hours of the scheduled time, or you do not show for your appointment time, a fee of $75 will be charged to your account. That fee will need to be paid prior to scheduling another appointment.

By signing below, you agree to the terms listed in our financial policy.
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New Patient Registration

Dental History

Issues with your bite and/or jaw joint:

General Health:

Medical History

Radiograph Policy in Accordance with State Practice Guidelines

Written Financial Policy