We Welcome New Patients
At Sparkle Pediatric Dentistry, we accept new pediatric patients up to age 18. You will have the opportunity to meet with our dental team and get to know Henrico pediatric dentist, Dr. Holly Lewis. We are committed to educating you about your child’s dental needs and will answer any questions you may have concerning your child’s treatment.
Our goal is to provide your child with the highest level of dental care available today. Thank you for your confidence in our Short Pump dental office and we look forward to meeting you and your child.
To provide you with the most efficient new patient experience, please download and complete the forms below and email them to firstname.lastname@example.org. Our dental team will take comprehensive records and address any concerns or questions you may have. If you have any problems downloading the forms, please contact our office and we will gladly send them to you.
New Patient Forms
- Medical History
- Financial Agreement
- HIPAA Notice of Privacy Practices
- HIPAA Acknowledgement of Privacy Practices
- Guardian Permission to Bring Form
- Dual Insurance Form
Existing Patient Forms
Your Child’s First Visit
Your child’s first visit with us may include:
- Comprehensive oral examination
- Full mouth digital x-rays
- Oral cancer screening
- Oral hygiene instruction
- Teeth cleaning
- One-on-one consultation with our dentist to discuss your child’s needs, concerns, goals, and treatment options
During your visit, we will answer any and all questions about your child’s oral health. We will provide a detailed financial consultation to ensure your child’s treatments are timed effectively and affordably.
Insurance and Billing
At Sparkle Pediatric Dentistry, we can help you maximize your benefits. We recommend that you contact our office prior to your appointment to provide us with insurance information for verification of benefits. We accept most major dental insurances and will file most claims for you as a courtesy. We will provide you with an explanation of your dental benefits and financial responsibilities up front, and work with you to ensure financing, if needed.
We provide multiple financing options to ensure you can receive the treatments you need with a plan you can afford.