Our new patient forms are designed to provide Dr. Shankland with your current and past medical history and is an essential tool for evaluation and diagnosis. For your convenience, we have provided online fill-in or print and complete forms for you to bring to your first visit. Please call our office if you have any questions.
Print and fill out manually to either mail or bring to office.
Dental History Form
TMJ History Form
NICO History Form
Sleep Exam Form
We appreciate that you have chosen Dr. Shankland to provide excellent service for your dental needs. And, we know how important financial planning is to successful treatment. Below you will find our financial policy, payment options, and insurance information.
Cash, Check, Credit Cards
Our office accepts cash, check, Health Saving Cards, and all major credit cards (Visa, Mastercard, Discover, American Express) for payment.
CareCredit is an excellent resource for healthcare costs. Upon credit approval, there are flexible interest-free and low-interest extended financing.
Options Dental Assurance Discount Plan
We are pleased to announce our new in-office savings membership plan. This plan is designed for those who do not have a traditional dental plan. For a low yearly membership rate, our plan includes two routine cleanings and x-rays once per year, 15% off basic dental procedures such as fillings and 10% off major services such as crowns, bridges and dentures.
Our office participates with: Aetna, MetLife, Delta Dental, Connections Dental, and Cigna. (Some listed dental plans may use savings plans that we do not participate with. Please check with your dental plan for specific participation with our office.)
Our office does not participate with medical insurance plans. Inquire with your policy if they offer a network Gap exception to compensate gaps with out-of-network providers.
Medicare and Medicaid
Dr. Shankland is an “opted out” provider with Medicare and therefore, we enter into a private payment contract between patient/doctor and agree that neither party can submit claims to Medicare. We do not participate with any Ohio Medicaid program.