New Patient Information
We're thrilled to welcome you. Download your forms below, complete them before your visit, and arrive knowing exactly what to expect.
What to Expect on Your First Visit
Your first appointment is dedicated entirely to you — no rushing, no pressure. We allocate extra time for new patients so Dr. Hatahet and our team can truly understand your oral health history, goals, and any concerns you may have.
Comprehensive Oral Exam
Thorough examination of teeth, gums, bite, and soft tissues — including an oral cancer screening.
Digital X-Rays
Low-radiation digital radiographs to reveal hidden decay, bone loss, and issues not visible to the naked eye.
Periodontal Assessment
We measure gum pocket depths and check for early signs of gum disease — one of the most under-diagnosed conditions in America.
Your Custom Treatment Plan
If any treatment is needed, we walk you through a clear, transparent plan — procedure by procedure, with costs — before anything begins.
Please arrive 15 minutes early for your first appointment to allow time to complete any remaining paperwork. Downloading and completing the forms below in advance will help your visit start on time.
Schedule Your First Visit
Call either of our locations or book online — we'd love to hear from you.
Patient Intake Forms
Download, print, and complete all four forms before your first visit to make check-in fast and seamless.
Patient Registration Form
Start here — required for all new patients
Complete patient intake form covering your personal information, dental history, full medical history, allergies, and authorization for treatment at Caring Dental of Herndon.
- Personal information & contact details
- Dental history & current concerns
- Full medical history & health conditions
- Allergies & current medications
- Treatment authorization & consent
Financial Policy & Consent
Payment & consent agreement
Reviews our financial policies including insurance billing, payment methods accepted, and your authorization for treatment. Please read and sign before your visit.
- Accepted payment methods (cash, card, CareCredit)
- Insurance billing & co-payment policy
- Authorization for release of information
- Consent for treatment & photo use
Missed Appointment Policy
Cancellation & no-show policy
Our policy for cancellations and missed appointments. We require at least 24 hours notice to avoid a missed appointment fee. Please review and sign.
- 24-hour cancellation requirement
- How to cancel your appointment
- Late cancellation & no-show fees
- Signature & acknowledgment
Notice to Patient
Privacy practices acknowledgment
Acknowledges that you have received a copy of our Notice of Privacy Practices, which explains how we may use and disclose your health information.
- HIPAA privacy practices acknowledgment
- Patient or guardian signature
- Office use section for exceptions
Post-Operative Instructions
After-care for dental procedures
Important care instructions following dental procedures including extractions, fillings, crowns, root canals, deep cleaning, and denture delivery.
- Extraction after-care
- Fillings & crowns guidance
- Root canal & deep cleaning care
- Denture delivery instructions
Office Policy
Our approach & practice guidelines
An overview of our office philosophy covering preventive and restorative dentistry, infection control standards, composite fillings, emergency care, and fluoride treatment policy.
- Practice philosophy & approach
- Infection control standards
- Composite resin filling policy
- Emergency care & fluoride treatment
Prefer to fill out forms at the office? Please arrive 15 minutes before your scheduled appointment time. Our front desk team will be happy to assist you.
Office Policies
We believe in full transparency. Please read these policies before your first visit.
Full policy documents are included in the New Patient Registration form PDF.
Insurance & Financing
Quality care should never be out of reach. We work with most major insurance plans and offer flexible payment options.
Insurance Accepted
We are in-network with many major PPO dental insurance plans. Our knowledgeable staff files claims on your behalf and helps you understand your coverage and estimated out-of-pocket costs before treatment begins.
AmeritasLiberty DentalDelta DentalCignaMetLife+ MoreDon't see your plan? Call us — we likely accept it. We verify benefits before your appointment at no charge.
Flexible Financing
No insurance? No problem. We offer multiple financing options so you never have to put off the dental care you need.
- CareCredit — 0% interest financing available
- In-house membership plans for uninsured patients
- All major credit cards accepted
- Payment plans available — ask our team
- Estimates provided before all treatment
Ready to Join the Caring Dental of Herndon Family?
Download your forms, then give us a call or send a message to book your comprehensive new patient exam. We can't wait to meet you.
Or send us a message online →