Patient Portal

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.

Patient Forms

Print and fill out manually to either mail or bring to office.

Dental History Form

TMJ History Form

NICO History Form

Sleep Exam Form

Financial Policy

• 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 Financing

  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.
  

• Dental Insurance

  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.)
  

• Medical Insurance

  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.