What to Expect at Your First Visit
At your first periodontal appointment, we will review your health history and take x-rays necessary to make an accurate and complete diagnosis. We are interested in your well being, so please inform us of all pertinent medical facts.
Dr. Stevens will perform a thorough examination and will explain all findings.
Areas of concern and treatment options will be discussed. If your condition indicates the need for treatment, we will explain to you the methods that will be used. We will also discuss with you the amount of appointment time that will be necessary for treatment. In addition, a full report and a copy of the x-rays will be sent to your dentist. We welcome your questions; they are important to us.
To schedule an appointment with Dr. Carol W. Stevens, please call 941-743-7474
Monday - Friday, 8:00 AM – 5:00 PM
Once an appointment has been made, that time is reserved exclusively for you.
*Cancellations – Please provide 48 hours notice if you are unable to keep your scheduled appointment.
We look forward to seeing you!
For your convenience Patient Forms are below. You may print these forms, fill them out and mail them to us, or bring them with you at the time of your scheduled appointment.
You may also fax them to 941-743-2988.
Our office staff will tell you which ones are required for your visit.
Financial & Payment Information
Fees & Financial Options
Our fees will be discussed during your initial visit. We appreciate payment at the time of service; otherwise, special financial arrangements may be made with our business office.
We accept VISA and MasterCard
Citi Health Card is also available to offer payment flexibility so you can start periodontal treatment immediately. Please ask our office about the one year no interest payment plan. You may apply at our office.
Dental Insurance Claims
If you have dental insurance, please bring your insurance card and information necessary to process your forms. Benefits vary from plan to plan, so please check with your insurance company to verify covered services.
All your insurance claims will be filed by our office. You may be responsible for a deductible and the percentage that your insurance company requires at this visit. If we are not a complimentary in-network provider for your insurance company, we will complimentary submit your dental claim, however, we may expect payment in full at the time services are provided.
All new patients requesting dental services are required to fill out patient registration forms and submit them before your first dental appointment. For your convenience, all patient forms are available on our website.
You can print this form, fill it out and fax it to 941-743-2988, mail it to our office, or bring it with you for your scheduled appointment.
Medical Records Release
A Medical Records Release Authorization is required for Port Charlotte, FL Periodontist Carol W. Stevens, D.D.S., M.B.A., to retrieve your medical records from another doctor or medical facility. You can print this form, fill it out and mail it to our office, fax it to 941-743-2988, or bring it with you for your scheduled appointment. By submitting this form you are authorizing Periodontist Carol W. Stevens, D.D.S., M.B.A. to retrieve your medical records.
You May Refuse To Sign This Acknowledgment.
This form acknowledges you have received our Notice of Privacy Practices. You can print this form, fill it out and fax it to 941-743-2988, mail it to our office, or bring it with you for your scheduled appointment. By submitting this form to Port Charlotte, FL Periodontist Carol W. Stevens, D.D.S., M.B.A. you are Acknowledging you have received a copy of this office’s Notice of Privacy Practices.