Patient Information

Patient forms

Please fill out our online new patient forms prior to your first visit. Bring the completed form to your visit, or email it to info@fairfaxgentledental.com. You can fill it out in our office if you are not able to complete it beforehand. Please bring your insurance card and your driver’s license to your first visit. This will help to shorten your appointment time.

We are participating providers with the following dental insurance plans:

AETNA PPO
Out-of-Network with
Federal Insurance

www.aetnadental.com

.

AMERITAS
www.ameritas.com

.

CIGNA PPO
Excludes Advantage Plan

www.cigna.com

.

DELTA DENTAL PPO
www.deltadental.com

.

DELTA DENTAL PREMIER
www.deltadental.com

DENTEMAX PPO
Select programs

www.dentemax.com

.

DOMINION NATIONAL PPO
Select plans
dominionnational.com
.

GEHA CONNECTION DENTAL
www.gehadental.com

.

GUARDIAN PPO
Select plans

www.guardiananytime.com

HUMANA PPO
Out-of-Network with
Federal Insurance

www.humana.com/dental-insurance/ppo
.

METLIFE PPO
Out-of-Network with
Federal Insurance

metdental.metlife.com
.

PRINCIPAL PPO
www.principal.com

.

UNITED HEALTHCARE PPO
www.myuhcdental.com

.

Please call our office if you do not see your insurance listed above.

FAQs

  • In many cases, dental insurance will pay for all or a portion of your dental care. If you provide us with complete insurance information, we’ll be happy to bill your insurance carrier. However, because insurance policies vary, we can only estimate your coverage in good faith; we cannot guarantee coverage, due to the complexities of insurance contracts.

    Please remember that your specific policy is a contract between you and your insurance carrier. You are responsible for your total obligation for dental services provided by our practice, should your insurance benefits result in less coverage than anticipated. Copayments, deductibles, and remaining balances are your financial responsibility, as are any denials.

    If an insurance carrier has not paid within 60 days of billing by our practice, any unpaid fees are due from and payable by you. As a courtesy, we can also file a pre-estimate for treatment at your request. This will give you the opportunity to see what your insurance might cover on your treatments.

  • If you have changed insurance plans, please let us know immediately so we can process your claim correctly. You can call us at (703) 352-5222, or email us at Info@FairfaxGentleDental.com

  • In addition to accepting most dental PPO plans, our practice accepts cash, checks, Discover, Visa and MasterCard as well as other forms of payment.

    We aim to provide the finest dental care at the most reasonable cost, but please note that we can only do so if our patients pay promptly for services — at the time the services are rendered.

  • We request you to inform us at least 24 hours in advance if you’re unable to keep your scheduled appointment, so another patient can be treated during that time. In turn, we will strive to make sure the doctor sees you promptly when you come in, and call you in advance if we need to reschedule your appointment.

  • Understanding your overall health helps us provide the best dental care possible. We encourage you to share all of your health history, even if it doesn’t seem related to your teeth or mouth—many health conditions can impact oral health. Be sure to let us know about any changes since your last visit.

    Also, please bring a list of any medications you’re taking, including both prescriptions and over-the-counter/herbal/homeopathic products.