Patient Forms
What to Expect When You Visit:
Our patient coordinator will make the process of scheduling appointments and treatments simple. You can also book your appointments online. Within our state-of-the-art practice, you’ll visit a dental hygienist and the doctor.
What You’ll Need to Get Ready For Your First Visit:
- Form of identification
- Insurance card if using insurance
- Current list of medications, health history
Patient Forms
LANAP® Forms
Insurances & Financing Options:
The doctors at Dominion Smiles don’t want finances to stand in the way of anyone’s treatment plan. In addition to accepting most PPO insurances, they also offer Care Credit financing options. They also established an in-house membership program that offers specially priced services.
No Dental Insurance? Join Our Patient Membership Program Today!
•No Deductibles •No Claim Forms •Immediate Eligibility •No Yearly Maximums •No Pre-Authorizations
Child
(3-13)
$299
* Normally $470
- 2 Clinical Exams
- 2 Professional Cleanings
- All Scheduled Digital X-rays & Intraoral Photos
- 15% Off All Dental Procedures
Adult
(14+)
$350
* Normally $534
- 2 Clinical Exams
- 2 Professional Cleanings
- All Scheduled Digital X-rays & Intraoral Photos
- 15% Off All Dental Procedures
Adult
(Perio +)
$799
* Normally $1,010
- 2 Clinical Exams
- 4 Perio Maintenance Cleanings
- All scheduled digital X-rays & Intraoral Photos
- 15% Off All Dental Procedures
21715 W I-10, Suite 105, San Antonio, TX 78256
info@dominionsmiles.com
Office Hours:
Monday-Thursday: 8 a.m. - 5 p.m.
Friday : 8 a.m. - 1 p.m.
Extended hour by appointment only.
