Forms & Finance

Downloadable Forms, Financing & Payment Methods

Patient Forms

All of our patient forms are available for download/print for existing or new patients. These include New Patient, Financial Agreement, HIPAA Notice of Privacy Practices, and Oral Cancer Screening forms.

Methods of Payment

CIGNA and DeltaDental Insurance accepted.

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All major credit cards are accepted – Visa, Mastercard, American Express, Discover.

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Financing

We accept financing from CareCredit.

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Any information submitted to Dr. Coat’s office is confidential. Our Consent for Use and Disclosure of Health Information policy provides the information that federal law requires us to give our patients regarding our privacy practices.

New Patient Form

Dr. Brian Coats, your Dentist in Longmont is always welcoming new patients to our office. Request a new patient exam or fill out a patient health history.

Patient Financial Agreement Form

This form provides new and existing patients with our financial policy and agreement regarding payment for dental services.

HIPPA Notice of Privacy Practices Form

The Notice of Privacy Practices and Consent for Use and Disclosure of Health Information forms provides the information that federal law requires us to give our patients regarding our privacy practices. If you are transferring from another office to ours it would be helpful to have any previous records forwarded to us.

Oral Cancer Screening Acceptance Form

Our practice continually strives to provide important enhancements in oral health care for our patients. We are concerned about oral cancer and look for it in all at risk patients.

Schedule an exam with Dr. Coats, your hometown dentist in Longmont.

Beautify Your Smile & Your Life

It’s Easy To Get Started. Call (303) 776-4090

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Call our dental office at 303-776-4090 and you will speak with Carrie or Renee. They will answer any questions you have and assist you in scheduling a visit. Or you can contact us online by completing the short form.

FOR APPOINTMENT COMPLETE FORM AND SUBMIT