All ADULT Paperwork (ages 16 and above)

 

This includes all paperwork needed for your first visit to our office. Please print each page, fill it out at your convenience and bring it with you to your first appointment. You may keep the privacy information for your records but, please return the signed page.

 

All CHILD Paperwork (ages 0-15 years)

 

This includes all paperwork needed for your child’s first visit to our office. Please print each page, fill it out at your convenience and bring it to your child’s first appointment. You may keep the privacy information for your records but please return the signed page.

 

Medical History

 

This form is for EXISTING patients only. On occasion, as a patient you will be asked to update your medical history information. If we have asked you to do so, or if you know you have changes to make, please print this form and bring it to your next appointment.

 

Privacy Practices

 

You may keep the information pages for your records but it is mandatory that we have a signed copy in your records at our office. This is for existing patients only.

 

Office Policies

 

This form is included in all adult and children paperwork above but you may be asked to update your signature or sign one if we do not have one on file. Please read this form carefully, print and bring it to your next appointment if we have asked you to do so. This form covers specific insurance policies, broken appointment fees, and financial responsibilities.

 

Office Policies and Misc. Information

 

Chip E. Webb, DDS offers the following discounts:

 

Senior Citizen Discount - 5% discount off all services.

This discount is applied to seniors WITHOUT insurance and who are 65 years old and older at the time of their appointment.

 

Cash Discount - 5% off all services with a CASH payment.

Unfortunately, we cannot offer this discount with a check or credit card payment. The services must be paid in FULL to receive this discount.

 

*These discounts CAN be combined but will do so for a total of 7% off of the total treatment cost.

 

Inclement Weather

Chip E. Webb, DDS follows the Maryville City Schools schedule in regards to inclement weather for the 8:00AM AND 9:00AM APPOINTMENTS ONLY. If Maryville schools are closed and you have an appointment for one of these times, your appointment WILL BE CANCELED and someone will call you as soon as we are back in the office to reschedule. Anyone having an appointment at a time other than stated above will be called regarding the status of our office hours. If we are expecting bad weather please make sure we have updated telephone numbers for you so that we can reach you when needed.

 

After Hours Emergencies

If you are a patient of record and have an emergency after hours, please call our office at 865-380-5485 and follow the directions there.

Please call 911 or report to the nearest emergency room IMMEDIATELY if you feel that your condition is serious and you are unable to reach us.

 

Cancellations and Broken Appointments

If for some reason you need to cancel your appointment, please call with at least a 24 hours notice so that we may have adequate time to fill your appointment slot. Patients who do not allow us this notice may be subject to a $25 per hour broken appointment fee.

 

Patient Info

708 Morganton Square Dr.

Maryville, TN 37801

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