Dentist Portsmouth Patient Forms

For your convenience, please fill out the forms below and bring them with your next visit. This ensures to speed up your check in process:

 

Medical History Form

 

Medication Form

 

Record Release Form

 

HIPPA Policy

 

Map to Dr. Spivey's Office

 

We offer three options for financing your treatment costs.

 

  • Payment in full with a book keeping courtesy of 5%. This courtesy only applies to payments made by cash or check and only when the patient is responsible for treatment fees over $1,000.

 

  • Outside Financing through Care Credit. This option is widely used by our patients due in great part to the 0% interest rate for 6 month financing and low interest options for extending out the payment timeframe. To apply please visit www.carecredit.com or call (800) 365-8295. The application process must be completed prior to your surgical appt.

 

  • Payment by credit card. For your convenience we accept Mastercard or Visa.