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After Hours Emergency Number:
We are aware that you have many choices in dental
offices and we appreciate you picking us.
- Please consider your initial appointment request pending until all requested documents are submitted and the Teledentistry Consent Form is signed and returned.
- All Teledentistry communications will be via phone, email and video conferencing.
- Instructions for video setup will be provided, a web camera on a computer or phone application will be required for this feature.
If you want to be efficient, please complete the
forms below at the same time as contacting us.
Complete and submit all the forms below:
Please click on each of the links below to complete and submit the forms. It is very easy.
Teledentistry Consent Form
Privacy Practices Acknowledgement Form
Consent for Dental Treatment Form
Medical History Form
Covid-19 Pre-appointment Screening Questionaire
Photos and x-rays submission:
Please use your phone to take photographs of yourself and your tooth. Take a full face image and an extra oral close-up photo of the affected side. In addition take several close-up photos of the tooth causing the problem.
If you have any x-rays of the areas of concern please send them along with the photos to this secure email address HSDC@aspidamail.net make certain you write the word "ENCRYPT" in the subject matter.
If you have any current x-rays of your teeth with another dentist please ask them to send the x-rays to secure email address HSDC@aspidamail.net make certain you write the word "ENCRYPT" in the subject matter..
Upon receipt of this information we will contact you via email with a scheduled Teledentistry Video Conference appointment.
Payment options for Teledentistry Consultation
- The fee for the Teledentistry Video Consultation is $40.00.
- We are unable to bill insurance for this service. Insurance plans may or may not have coverage for Teledentistry. We recommend you contact your insurance and determine your benefits. We will provide documents so you can self bill if needed.
- You will receive a PayPal invoice due upon receipt and in advance of the consultation.
- You may call the office (530) 541-7040 and provide a credit card for the payment due in advance of the consultation.
- Refund policy. There are no refunds upon completion of the Teledentistry Video Conference appointment.