If you would like to request an appointment, please e-mail us and include the following information in your e-mail:

Preferred Day:

Preferred Time:

First Name:

Last Name:

Home Phone:

Cell or Work Phone:

Email Address:

Have you ever been a patient on our office before?

Nature of your appointment:

Please note that electronic mail is only read during normal office hours.

Your personal information is for our dental office only and will be used solely to contact you. We will not give away or sell your information to anyone.

Welcome to Defiance Dental Group and thank you for choosing us as your partner in dental health! We would like to make your experience here as convenient as possible. If you have any questions, please feel free to ask any staff member for help.

After you schedule your first appointment you may print out your new patient forms here. If you are representing a minor, you may click here for the forms. Below is some additional information and some commonly asked questions regarding your first visit with Defiance Dental Group.

• What should I bring to my first appointment?

• • Insurance Card
• • Identification – ID, Driver's License, etc.
• • Recent dental x-rays if available
• • All of your completed and signed new patient forms, including a list of current medications

• How early should I arrive to my first appointment?

Please arrive 15-30 minutes before your scheduled appointment. This enables our staff to correctly add your information to our database and verify any insurance that you may have.

• How Are Appointments Scheduled?

Our office schedules appointments at your convenience whenever time is available. Since appointment times are reserved exclusively for each patient, we ask that you please notify our office 48 hours in advance of your scheduled appointment time if you are unable to keep your appointment. This will enable another patient who needs our care to then be scheduled if we have time to notify them. We realize that unexpected things can happen, but we ask for your assistance in this regard. Missing an appointment without 48 hours notice will result in a missed appointment fee that must be paid prior to being given another appointment.

The doctors at Defiance Dental Group care deeply about your dental health and our support team will make every effort to make your visits as comfortable as possible.

If a patient should require extensive treatment, you will be given a comprehensive treatment plan in writing along with our current fees. Our financial manager will work with you on an individual basis to help make your treatment a possibility.

In an ongoing effort to provide quality dentistry at an affordable cost to our patients we ask that services be paid for at the time of service. For your convenience we accept cash, check, Master Card, and Visa. If dental insurance is available to you, we do ask that you pay any estimated co-pays at the time of your visit.

Care Credit & American General

As a participating Care Credit office we are able to offer no-interest and extended payment plans, with low monthly payments to our patients. Click here to apply for Care Credit now.

Financing options are also available through American General for extensive treatment plans.

Insurance Carriers

We accept and honor most dental insurance plans.

As a courtesy to you, we will be happy to research your dental plan benefits to determine an estimate of what your plan may contribute toward your treatment. We provide detailed, electronic claims billing and are committed to maximizing your benefits. Please know however that treatment planning is based upon your dental health needs, not on what your insurance company will pay.

Insurance FAQ

What's the difference between Indemnity, PPO, HMO, & Discount insurance plans?

Indemnity or Traditional Insurance reimburses members or dentists at the dentist's UCR (Usual, Customary & Reasonable fee). This allows the subscriber to go to any dental office without being limited to a panel.

PPO (Preferred Provider Organization) is the most common form of insurance. They provide members with a list of participating dentists to choose from. The dentists on this list have agreed to a lower fee schedule, which provides you with greater cost savings. They also assist with insurance billing. Most companies pay 50% on major treatment (crowns, bridges, partials), 80% for basic care (fillings), and up to 100% for preventative care (exams, x-rays, basic cleanings). Annual maximums generally range from $1,000 to $2,000.

HMO, also known as capitated or prepaid insurance, was designed to provide members with basic care at the lowest rate. Participating providers receive a monthly capitation check for patients assigned to the office. This amount is only a few dollars and is intended to offset the administrative costs. HMOs generally don't pay for services rendered. Fees are usually greatly reduced, but the patient is solely responsible for paying the doctor.

Discount Plans simply consist of a panel of dentists that have agreed to a reduced rate, with the subscriber being solely responsible for the entire portion. There is no billing or annual maximums.

What's a covered benefit?
Treatment that is recommended by a dentist, is listed on the fee schedule, and accepted under the terms of your group's plan.

What's optional treatment?
Treatment that is either not listed on your fee schedule or more than the minimum to restore the tooth back to its original function.