Please bring your current insurance information to every appointment. We copy your insurance information each time you come to our office. We will also ask you to update your address, phone numbers, and email address at each appointment. These policies help us maintain contact, and are extremely beneficial and important to ensure your appointments and procedures are paid for by your insurance company.
We strive to keep paperwork to a minimum. Therefore, the only paperwork we require is New Patient Registration and Acknowledgment of Privacy Practices. Optionally, we provide a Consent for Internet Communications. Completion of this form will allow Dr. Burket's office to communicate with you regarding account information, appointment information and clinical information via the the internet.
For your convenience, you can print these forms from your browser, and fill them out at home. Please bring them with you on your first visit to the office. These forms require Adobe Acrobat Reader. If you don't currently have a copy of this program, you can download a free copy here.
New Patient RegistrationAcknowledgment of Privacy PracticesConsent for Internet CommunicationsAlternately, you can download the New Patient Registration form in Word2007 format, and return it using the email link provided:
New Patient Registration (Word2007)SECURITY ISSUE: To ensure your personal information is securely transferred to us, you must email your attachment using this email link: Send Secure Email.
Health and Dental History: Since patients' needs change constantly, Dr. Burket and his staff will go over your health and/or dental history with you at the time of your appointment. So there's no need to fill out lengthy forms prior to your visit!
Acknowledgment of Privacy Practices form includes a summary of Privacy Practices which requires your signature, therefore, we don't provide you with the extensive version of Privacy Practices. If you'd like a detailed, printed version of this federal policy, please request a copy at your next visit.
BRADLEY J. BURKET, DMD, MD
2195 NE Professional Court, Suite 1
Bend, OR 97701