Located below are registration and medical history forms. We ask you to complete these forms prior to your appointment and bring them with you. Additionally enclosed are our Financial and Office Policy and some general information you might find helpful. Kindly read through these enclosures as we will ask you to endorse them with your signature when you arrive for your appointment.
1. Financial & Office Policy Form
2. Patient Medical History Form
3. Patient Registration Form
4. Patient Records Release to Bay Breeze Form
5. Authorization for Release of Identifying Health Information
6. Notice of Privacy Practices
7. KOR Whitening Informed Consent Form
8. Composite Fillings & Your Insurance
9. Velscope: The Oral Cancer Screening System
10. Zoom In Office Consent Form
11. Zoom Take Home Trays Consent Form
X-RAY REQUIREMENTS FOR NEW PATIENT EXAM VISIT
There are two different kinds of x-rays that dental offices may take, full mouth x-rays and/or panorex. The full mouth series of x-rays are 18 to 21 individual x-rays of the mouth that are detailed individual x-rays for proper diagnoses of cavities, bone pathology, etc. A panorex x-ray is one x-ray taken from outside of the mouth. This x-ray helps to show bone placement and tooth location, but does not necessarily show clear indication of cavities or decay. This x-ray would be needed primarily by an oral surgeon (for wisdom teeth removal or implant placement) or an orthodontist (determining tooth positioning).
Breeze Dentistry requires that patients have a full mouth series of x-rays taken either by this office (as part of our new patient exam) or your previous dental office. We typically require that the full mouth series be taken every three years, however, some insurance companies will only compensate patients for a full mouth or panorex x-ray every five years. When this is the case, we will wait five years to accommodate the patient's budget, supplementing our periodic reviews with bite wing x-rays (a smaller series of four individual x-rays, see example below).
FULL MOUTH SERIES OF X-RAYS
(REQUIRED FOR GENERAL DENTISTRY WORK AT BAYBREEZE)
The full mouth series of x-rays is required by our office on the day of your new patient exam. If you already have had a full mouth x-ray taken from your previous dentist and it is not outdated, then we may use it during your patient exam. The only x-rays that will be required are bite wings (see picture example below) if you have not had them within 6 months of your new patient exam or last cleaning.
(NOT ACCEPTED FOR GENERAL DENTISTRY WORK AT BAYBREEZE)
Unfortunately, the panorex is not acceptable by Dr. Santana because they do not provide an accurate diagnosis of cavities or decay between your teeth. As you can see, the teeth are not as well detailed as the full mouth x-ray shown above.
BITEWING X-RAYS (CHECK-UP X-RAYS)
These types of x-rays are usually taken during your cleaning appointments once or twice a year according to your insurance or once a year if you have no insurance. These x-rays allow us to see cavities that may be located between your teeth.
Children 17 and younger usually only have bitewings taken. When patients turn 18 years old, they then have a full mouth x-ray taken.