For your convenience, Brothers Dental has made your patient forms available online. We encourage you to download, print, and fill them out before your first appointment with our dentist in Colorado Springs, Colorado. If you have questions about our forms, and to make your appointment with Dr. Alan and Cory Andrews, please contact our office at 719-599-7453. We will be happy to assist you.

 We are delighted to Welcome you to  Brothers Dental (FORMERLY CRABTREE DENTAL CENTER) and are pleased that you chose us to take care of your dental needs. We strive to provide superior dental care at reasonable prices and are dedicated to serving our patients.

Our goal is to help you feel and look your best through excellent dental care, and to provide you with the best care and services possible.  Also to treat you with respect as if you were a family member and we hope that you feel you can ask any of our staff members questions as they arise.  Our Mission : To make our community SMILE!

Financial Agreement

Thank you for choosing our office for your dental needs.  We do our absolute best to help you understand and estimate your insurance benefits.  As a courtesy, our office will verify your insurance with your insurance carrier as long as you provide us with your up-to –date and correct insurance information.  Keep in mind all insurance companies include a disclaimer stating verification does not guarantee payment.  Due to the thousands of insurance plans we ask that you know your benefits for it would be impossible for us to know them all.  Each insurance plan is unique in what services they will allow.   We must emphasize that as your dental care provider, our relationship is with you, our patient, not with your insurance company.  Please be aware that your dental insurance plan is a contract between you, your employer, and the insurance company.  It is your responsibility to know the benefits, limitations and exclusions of your dental plan.   If you are unhappy with its specific coverage, please contact your Human Resources Department.  Only your employer can adjust benefits or change policies.  We are not responsible, nor can we guarantee, how your insurance carrier will pay on a claim.  Once the insurance carrier has paid their portion, the remaining balance will become your responsibility.

Please note that treatment plans change on occasion during the course of treatment because conditions can worsen or improve and can therefore change your financial responsibility in either direction.

Your estimated deductible and/or copay is due at the time services are rendered.  Because your insurance company makes no guarantee of payment, we cannot always guarantee your exact insurance coverage.  Therefore, you may receive a statement with an additional balance after your insurance has met their obligation.  We are always available to answer your questions and/ or assist you in any way we can.

I understand that any insurance estimate given to me by this office is not a guarantee of actual insurance payment.  I also understand that I am ultimately responsible for all charges incurred for dentistry performed upon me or my dependents in this dental office and that it is my responsibility to notify the office of any changes in my insurance.

 NO-SHOW/Late Cancellation Policy

Our office policy states that 3 No-Shows or Late Cancellations are considered to be excessive.   Patients who have no-showed, missed their appointment time, or failed to cancel/reschedule with at least 24- hour notice will be dismissed from the practice on their third violation.   The providers and staff understand that there are occurrences that can prevent you from making your appointment time; it is due to this that we have extended the 3 occurrence policy.  ALL late cancellations and missed appointments are subject to $50.00 charge per hour that you are reserved.  This fee will need to be paid in full before reserving any more appointments.

Time is specifically reserved for you on our schedule when you make your appointment.  When sufficient notice is not given to cancel or reschedule your appointment, it does not give us enough time to contact another patient who could come to the office during your assigned time.  This can result in other patients not getting the care they need, when they need it.  We strive hard at Brothers Dental to meet and exceed the expectations of all our patients and we are dedicated to providing you with the best dental care and service possible.  We also strive to meet your needs as much as possible.   We will respect your time and only ask this in return

(THIS FORM ABOVE WILL NEED TO BE SIGNED AT THE FIRST APPOINTMENT)

Forms to fill out online  (must do this on a PC or Home Computer-   Phones will not let you complete forms)

NEW PATIENT FORMS

EXISTING PATIENTS UPDATE

or you may Print and Bring In the Following:

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