Patient Area

This section will help you gather all of the information you will need before your first visit to see Dr. Churney. In the Patient Info section you will be able to read more about what to expect on THE FIRST APPOINTMENT, as well as detailed information on our FINANCIAL POLICY, INSURANCE POLICY. The final section will be an extensive list of PATIENT FORMS you will find useful before, during, and after your visit with Dr. Churney.

Please download and complete your patient registration form. Be sure to bring it with you to your first appointment. It is important that you list any medications, allergies or other pertinent information that could affect your dental care.

If you are like most visitors to Dr. Churney’s office, then you have been referred by your primary dentist. In referral cases we will have had all the information related to your referral sent over to us for review prior to your first visit.

Returning Patients
As always it’s a pleasure to have you visit our office. Please let us know if any of your personal contact information, insurance information, or medical history has changed since your last visit. **Especially important** is if you are on any new medications that Dr. Churney may not be aware of since your last visit with us.

Digital Radiographs…X-rays
Dr. Churney’s office uses digital radiograph for taking periodontal images. The digital radiograph offers instant images, without substantially less radiation then traditional x-rays.

Your First Visit

Referrals
Most of Dr. Churney’s or Dr. Adam’s patients have been referred by their primary dentist for evaluation. A periodontal evaluation is the most thorough way to detect gum disease. It’s a good bet, if your dentist asked you to call Churney Periodontal, they did so with your health in mind.

If you weren’t referred, that’s ok, too. We applaud your willingness to be proactive in your dental well-being! Many studies show that our dental health and our overall health are closely linked. As we like to say, healthy gums for healthy lives.

Initial Evaluation
Your first visit will be a thorough evaluation followed by a discussion of our findings. So that we can properly prepare you, we typically do not schedule initial exams and treatment on the same day; we want to make sure you have all the information you need, and that all of your questions are answered prior to any treatment being provided.

If you have been referred by your dentist, this will give him/her time to send over necessary information to make the best assessment for your dental health.

Ask Questions
A large majority of people don’t know what a Periodontist is until they are referred to one. That’s ok! Feel free to ask as many questions as you need to feel completely comfortable. Churney Periodontal will provide you with all the information you need to make the decision that is best for you. Your dental health is our number one concern, and providing the most current research, up-to-date procedures, and information is a priority for us.

Think of a question later, call us!

Patient Rights

Relationships between consumers or patients and health care professionals are most rewarding and likely to result in good results when there is open communication and active participation of patients in the treatment process.
Patient participation in treatment is an important part of following treatment directions, and following directions improves care and treatment.

Patient Rights

To receive considerate and respectful care.
To receive an explanation of your diagnosis, and treatment in a language and terms you can understand.
To receive the necessary information to participate in decisions about your care and to give your informed consent before any diagnostic or therapeutic procedure is performed.
To expect that your personal privacy will be respected by all staff members at Dr. Churney’s office.
To expect that your medical records will be kept confidential and will be released only with your written consent, incases of medical emergencies, or in response to court orders. (Confidentiality can be breached if the individual poses a significant threat of harm to self or others).
To know the names and positions of people involved in your care by official name tag or personal introduction.
To ask and receive an explanation of any charges made by Dr. Churney’s office, even if they are covered by insurance.
To review any medical records created and maintained by Dr. Churney’s regarding your care and treatment.
To be given the best possible health care. In certain cases, another facility may have services that Churney Periodontal does not have. You will be referred to that facility after you have received complete information about the referral.
To care which takes into consideration your psychosocial, spiritual, and cultural values.
To file a formal grievance to resolve complaints or disputes. A form to initiate this process will be provided to you upon request.

AAP-Periodontal-Patients-Bill-of-Rights-and-Responsibilities

Click here to view HIPAA Policy Online

HIPAA, which stands for the American Health Insurance Portability and Accountability Act of 1996, is a set of rules to be followed by doctors, hospitals and other health care providers. HIPAA took effect on April 14, 2006. HIPAA helps ensure that all medical records, medical billing, and patient accounts meet certain consistent standards with regard to documentation, handling and privacy.

Financial Policy

Churney Periodontal is proud to be a team whose primary mission is to deliver the finest and most comprehensive periodontal services available today.
We are concerned about your dental care and want to ensure that it is performed in the most responsible manner. In order to assist you with the investment in your dental health, we have outlined our financial policy.

All accounts are due and payable at the time any services are rendered unless other arrangements have been made. Our bookkeeping policy prevents us from carrying balances of 90 days, unless there is an insurance issue related to it.

Methods of Payment
Cash, Check, or Credit Card
Check (Personal or Certified), Cash or Credit Card (MasterCard, Visa, Discover, or American Express) are accepted for payment of services. As always your dental health is our primary concern, so feel free to discuss with us possible payment options.

Care Credit
Care Credit is a program that offers no interest payment plans (3, 6 & 12 months) or extended payment plans for treatment fees upon approved credit.

For more information they can be contacted directly at 1-800-365-8295 or online at: www.carecredit.com.

Patient Forms & Documents

We include a list of all of the forms and documents that are included in our New Patient Packet. Churney Periodontal has placed these forms online so you have the opportunity to reference them, to read over them before your first appointment, or even print them ahead of time and fill them out.

These forms will always be available to you in our office and there will always be a staff member available to go over the information with you if you have questions or need assistance with the forms.

New Patient Packet

Dr-Churney-Patient-Form

Directions / Map

Notice of Privacy Practices / HIPAA
Notice of Privacy Practices / HIPAA

Click here to view HIPAA Policy Online|
HIPAA, which stands for the American Health Insurance Portability and Accountability Act of 1996, is a set of rules to be followed by doctors, hospitals and other health care providers. HIPAA took effect on April 14, 2006. HIPAA helps ensure that all medical records, medical billing, and patient accounts meet certain consistent standards with regard to documentation, handling and privacy.

Patient Area

Your First Visit

Patient Rights

Financial Policy

Patient Forms & Documents

Churney Periodontics Office Location

Churney Periodontics Dental Service

727-799-6733