Burleson Pediatric Dentistry
A Great Dentist

New Patient Forms


New Patients

Save time waiting in our office by filling out necessary forms online - feel free to give us a call if you have any questions.

Current Patients

To print and complete forms out at home use links below.

Click the following link to learn more about their first visit:

Get More Information About Your Child's First Visit!

Appointment Policy

We are aware of school policies that make it difficult for children to be out of school for any reason. However, please remind the schools that medical and dental appointments are excused absences.

•    The office attempts to schedule appointments at your convenience and when time is available.
•    Preschool children should be seen in the morning because they are fresher and we can work more slowly with them for their comfort.
•    School children with a lot of work to be done should be seen in the morning for the same reason.
•    Missing school can be kept to a minimum when regular dental care is continued.
•    Arriving 10 minutes late or more for any appointment may require rescheduling so other patients are not kept waiting. This is considered a broken appointment.

When we schedule an appointment for your child, that time is reserved solely for your child. We do not double book and we take pride in the fact that because we value your time, as much as we hope you value ours. We make every effort to see your child at the time scheduled. For this reason, it is very important that you have your child in the office at the time scheduled.

If you are unable to keep a scheduled appointment, a 24-hour notice is required. We understand that unforeseen emergencies do occur, however, we reserve the right to charge your account a $25.00 fee for repeated last-minute cancellations or broken appointments.


Financial Policy

Payment for professional services is due at the time of dental treatment. We accept cash, checks, and credit cards. (VISA, MasterCard, Discover, and CareCredit).

Insurance Payment Policy

Because insurance companies contract with you, not with us, we cannot be responsible for amounts that are not covered by your insurance and out-of-pocket expenses. We file your claims as a courtesy to our patients and will do our best to maximize your benefits. However, because of the thousands of different insurance plans that exist, it is up to you to know your coverage and benefit details. 

If we do not receive payment within 45 days, you will be responsible for the remaining balance on your account.

The parent or guardian who brings the child to their appointment is responsible for payment at the time of service. We cannot send statements to alternate addresses in the event of a divorce decree or settlement.


Insurance Companies

We accept all PPO insurance plans and are in-network with the following:

  • Cigna
  • Delta Dental
  • Guardian
  • Ameritas
  • United Concordia
  • Principal
  • Sunlife Financial
  • Assurant
  • Aetna

Payment Options

We accept cash, checks, and all major credit cards.

Click Here to Pay Online!

Membership Plan

Click here to view more information

If you have difficulty using our website, please email us or call us at (817) 447-7474
View the ADA Accessibility Statement