Choosing a dentist for yourself and your family is a big step, and at Burgess Dental, our dentist and team want you to feel comfortable about your first visit and every visit after that. To help you prepare for your appointment, we have provided the patient resources below.
If you would like to make an appointment with Dr. Louis Burgess or have questions about your dental care in Cordova TN feel free to reach out to use at (901) 756-8111.
New Patient Paperwork
Your first visit with our dentist should be focused on discussing and achieving the goals you have for your smile. At Burgess Dental, we understand that your dental appointment in Cordova TN, needs to be convenient and work with your busy schedule, while at the same time maximizing the potential for your smile. On this page, you will find our patient forms, which you can either fill out online or print and complete before your visit at your own pace.
- Some forms are PDF files. You will need AdobeReader® to view them.
- If you do not already have AdobeReader® installed on your computer,
Click Here to download. - Download the necessary form(s), print them out and fill in the required information.
- Bring the necessary form(s) to your appointment.
Patient Forms – Click to Complete
Patient Registration and Consent- Click to Download
Medical History – Click to Download
HIPAA Acknowledgement – Click to Download
Notice of Privacy – Click to Download
By completing your forms prior to your visit with Dr. Louis Burgess, you will spend more time with our team and give our dentist the opportunity to study your medical history and begin creating your personalized treatment plan. If you have questions about your patient forms or would like to schedule your visit, please contact a member of our team at (901) 756-8111.
Financial Policy
We firmly believe that financial considerations should not be an obstacle to obtaining the treatment you desire. We are sensitive to the fact that each patient has different needs and have several payment options available so that treatment is accessible to everyone. All financial discussions and arrangements are kept strictly confidential.
To learn more about our financial policy, click here.
Insurance Information
Dental insurance is diverse. Some policies cover only a small percentage of fees, while others cover 50 percent or greater. The more you or your employer pays for premiums, the better the coverage, in most cases. Dental insurance can be confusing, but we’ll make it easy for you. Simply bring your card or claim into our office. We’ll be happy to tell you what your insurance will cover and file your claim for you.