Patient Registration Forms (.pdf)

Acknowledgement of Receipt of Notice of Privacy Practices (.pdf)

Referral for Root Canal Therapy (.pdf)

Hipaa Notice of Privacy Practices (.pdf)

PMP Form (.pdf)

Southside Endodontics, PC will accept and file any dental insurance plan for our patient’s convenience.

The doctor’s are participating providers for the following insurance plans:
Delta
Anthem
United Concordia
MetLife
Guardian
Cigna

We offer Care Credit plans and accept Visa, MasterCard and Discover.

We will call your insurance carrier to verify each patient’s benefits and get an estimated predetermination from your insurance company prior to the procedure.