Middletown and Port Jervis, NY (New York) Orthodontist Haesin Sabina Jung, DDS, PC

Please help us be prepared for your first appointment by completing this Patient Form. Download the form below in Word or PDF format, print it out, complete the form, and bring it with you to your first appointment.

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Family Orthodontics Mission Statement:
Quality Orthodontic Care, One Patient At A Time

FREE INITIAL CONSULTATION

Your First Visit
Prior to your first appointment, welcoming information will be mailed to you including a medical and health history form. Upon completion of a through examination, Dr. Jung will be able to answer the following questions:

Is orthodontic treatment indicated?
When is the correct time to begin treatment?
What treatment options are available?
How long will treatment last?
How much will treatment cost?

If treatment is indicated at this time, patient will be set up for diagnostic records appointment.

Records Visit
Complete diagnostic records typically include necessary digital x-rays, digital photos of patient’s face and teeth, plaster study models of the teeth. This information is used to confirm initial findings and develop a custom treatment plan for each patient. These records are also helpful in tracking the progress of treatment as the teeth move during orthodontic care.

Treatment Planning/ Consultation Session
After Dr. Jung has evaluated the clinical and diagnostic records, she will present in detail, her findings and the treatment options available. All the necessary paperwork will be mailed to the patient before treatment begins. If indicated, a separate treatment consultation session will be set up for difficult cases such as severe growth discrepancy and orthognathic surgery cases.

Treatment Time
The appointment when you get your appliances (braces, expanders, etc) usually takes 40-60 minutes. You will then see us at regular intervals 4-10 weeks. Those adjustment appointments are usually ten to thirty minutes long. If you cannot keep an appointment, please notify us at least 24-28 hours in advance. It may be difficult to get a convenient time (early morning/late afternoon) if you need to reschedule an appointment on a short notice. We make every effort to be on time for our patients, and ask that you extend the same courtesy to us.

Appointment Information
Middletown Office hours: Tuesdays and Fridays from 8:30-5:00 and two Saturdays a month from 8:30-1:30. Port Jervis Office hours: Wednesdays from 9:00-5:30. Administrative assistance is available from Monday to Friday from 9:00-4:30.

Our objective is to provide excellent orthodontic care while seeing each patient at his or her appointment time, and completing treatment by the estimated completion date. To accomplish this goal, it is imperative that our patients and their parents understand the manner in which we schedule our appointments.

In our office, long procedure and repair appointments are scheduled during work/school hours, so short appointments such as regular progress check ups can be accommodated after school/work hours.

Payment & Office Policies

Cost
The cost of treatment depends on severity of the patient’s problems. We will be able to discuss fees and payment options before treatment begins. We have payment plans to suit different budgets, including a no-down-payment option and third party financing. We also accept assignment from most insurance plans, file necessary papers to the insurance company. We work hard to make orthodontics affordable.

Fees
In an effort to keep orthodontic fees down while maintaining the highest level of professional care, we have established this financial policy:

If full payment is made at the onset of treatment, we will offer a 7% discount. (If you have insurance, we will offer a discount for payment of your portion of the fee that will not be covered by insurance.)

To fit your individual needs, financial arrangements can be made to extend your payments over a period of months by in-office plan at no interest charge

For your convenience, we accept payment by Visa and MasterCard
In cases of serious delinquency, treatment will be discontinued although we will make every effort to accommodate patients with temporary difficulties.

Insurance

If you have insurance, we will help you to determine the coverage you have available. We ask that you assign your insurance benefits to us. The balance will be arranged for you to pay (see above). We will help in every way we can in filing your claim and handling any insurance questions from our office on your behalf.

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