We Welcome New Dental Patients | Chestermere Lifepath Dental | Lifepath Dental & Wellness

We Welcome All New Dental Patients!

We Welcome New Dental Patients | Chestermere Lifepath Dental | Lifepath Dental & Wellness

Thank you for considering us for you and your family’s Health and Wellness needs! We look forward to the privilege of being your family’s care provider. Our Dental team strives to provide optimum health and wellness services in our state-of-the-art facility by offering our valued clients professional, safe, and compassionate care. We achieve this through a highly skilled and friendly team of professional health service providers.

We look forward to the privilege of being you and your family’s dental and wellness provider. Our facility is dedicated to quality care and is pleased to reserve time exclusively for each patient. If you are a new client, please download and complete the documents below to help facilitate your intake. Should you have any questions, please contact us at (403) 235-6208. Our friendly administration team will be glad to assist you.

New Dental Patients Are Welcome | Chestermere Lifepath Dental | Lifepath Dental & Wellness

The Lifepath Dental New Patient Experience

New Dental Patients Are Welcome | Chestermere Lifepath Dental | Lifepath Dental & Wellness

It is important to us that your experience with Lifepath is comfortable and welcoming each time. From the moment you walk into our office and are greeted by our Team, we want you to feel as if you are part of our extended family.

Your wellness provider and their team will take all the time necessary to discuss your specific health levels, needs, and goals.

Our facility is dedicated to quality care and is pleased to reserve time exclusively for each patient. We strive to keep your visit as efficient as possible, ensuring that it starts on time and ends on time. We follow up every visit so that you can provide us with your feedback on how we can further improve on meeting the needs of ALL our patients.

Our goal is to keep you aware of and utilize the latest trends in health and wellness. To accomplish this, we keep in touch with our clients via whatever technology they are most comfortable with. Whether that is by email, text message or even a simple phone call, we will make sure that it fits with your schedule to help you attain your wellness and health goals.

    Confidential Patient Information






































    Dental Information


















    OUR APPOINTMENT POLICY

    Thank you for allowing us the privilege of being your Dental Health provider. Our practice is dedicated to quality care and is pleased to reserve time exclusively for each patient.

    We respect our patients' time and make every effort to remain on schedule. Despite careful scheduling, dental emergencies can cause delays. If your appointment time is affected due to an unforeseen emergency, we will try our best to notify you in advance. We know that your time, like our Doctor’s, is valuable and we will make every effort to see you on time and will ensure you are given the same time and attention for your dental health.

    Because we reserve time exclusively for you, we ask that you make every effort to keep your reserved appointment time. If you find that you cannot keep your scheduled visit,we require a minimum of 2 business day’s notification. Advance notice allows our office to see other patients who may have been waiting to see us for needed treatment. We thank you in advance for your consideration.A charge of $75.00 may apply to your account if sufficient notice is not provided; this charge is at the discretion of your Doctor.

    Financial Policies for Patients with Dental Insurance

    (IMPORTANT: Please read and initial if you request direct billing to your Insurance, if you wish to pay in full for your dental treatment and be reimbursed by your dental plan, please omit this portion.)

    Many of our patients have dental insurance. While your dental insurance policy is an agreement between you and your insurance company, we will be happy to assist you in preparing and sending in the necessary forms. Please remember that no insurance company attempts to cover all dental costs. We cannot render dental treatment on the assumption that our charges will be paid in full by an Insurance Company. Full payment to our office remains your responsibility, regardless of how much your insurance does or does not pay. (Please see the attached information on dental insurance for more information.)

    I am aware that Lifepath Dental direct bills my Insurance Company as a courtesy to me and that in doing so, the dental office accepts no responsibility for any uncovered amounts, amounts over benefit maximums, limitations or plan restrictions, etc. I understand that the dental office collects my dental coverage information as a guideline ONLY to assist me in maximizing my benefits this does not hold them responsible for my dental account. Lifepath Wellness advises that I make myself very aware of my dental plan, knowing my coverage and that I ask my dental team about any and all procedures I am authorizing.

    Please email/bring in a dental plan breakdown (available online through your insurance provider) to chestermere@lifepathwellness.com. Lifepath Wellness advises me to contact my plan administrator or Insurance Company for questions regarding eligible procedures and authorization of treatment. And to make myself aware of all costs involved with my dental care. Lifepath advises me to keep track of my yearly maximums, limitations, appointment dates, and accumulated amounts used on my dental benefit plan.


    Payment is due at the time of service. I am aware that if the dental office does not receive confirmation from my Insurance for their exact payment—Lifepath Dental will estimate my portion only at the time of visit. Any unforeseen balances will then be informed to me by statement. I agree to pay all of these uncovered portions within 10 days from the date of statement or interest charges of 6% per month may be applied to my account. I agree to pay these interest charges if applied to my overdue account.


    I also understand that any uncovered procedures that may have been done at another Dental office are my responsibility. IMPORTANT: Please be advised that complete oral examinations (new patient exams) & x-rays will be denied by your insurance if you have had this procedure at another dental office within the time limitations on your specific plan. You are responsible for this procedure in our office should this not be an eligible benefit with your coverage.


    I am aware that NSF fees (returned cheques) are $50 for every returned personal cheque.


    I also understand that any uncovered procedures that may have been done at another Dental office are my responsibility. IMPORTANT: Please be advised that complete oral examinations (new patient exams) & x-rays will be denied by your insurance if you have had this procedure at another dental office within the time limitations on your specific plan. You are responsible for this procedure in our office should this not be an eligible benefit with your coverage.


    Consent for Treatment/Accountability Confirmation

    To the best of my knowledge, all of the preceding answers and information provided are true, complete, and accurate. I grant permission to you and your assignees to telephone me to discuss matters related to this form. I understand that this information is held in the strictest confidence and it is my responsibility to inform the office of any changes to my medical status. I authorize the dental office to perform any necessary dental services that I may need during diagnosis and treatment with my informed consent.

    I, the undersigned, clearly understand all policies of Lifepath Wellness Centre. I understand and agree to pay all fees associated with my dental treatment. With or without Dental coverage, I agree to make myself aware of those fees prior to any dental treatment I authorize to be done.




    Dental Office Personal Information Consent Form – Privacy Act Information

    We are committed to protecting the privacy of our patients’ personal information and to utilizing all personal information in a responsible and professional manner. This document summarizes some of the personal information that we collect, use and disclose. In addition to the circumstances in this form, we also collect, use and disclose personal information when permitted or required by law.

    We collect information from our patients such as names, home addresses, work addresses, home telephone numbers, work telephone numbers, and e-mail addresses. (Collectively referred to as “Contact Information”.) Contact information is collected and used for the following purposes:

    • To open and update patient files

    • To invoice patients for dental services, to process credit card payments, or to collect unpaid accounts

    • To process claims for payment or reimbursement from third-party health benefit providers and insurance companies

    • To send reminders to patients concerning the need for further dental examination or treatment

    • To send patients informational material about our dental materials

    • To follow up with treatment and/or customer services

    Contact information is disclosed to third-party health benefit providers and insurance companies where the patient has submitted a claim for reimbursement or payment of all or part of the cost of dental treatment or has asked us to submit a claim on the patient’s behalf.

    Financial information may be collected in order to make arrangements for the payment of dental services. We collect information from our patients about their health history, their family health history, physical condition, and dental treatments. (Collectively referred to as “Medical Information”.) Patients’ Medical Information is collected and used for the purpose of diagnosing dental conditions and providing dental treatment.

    Patients’ Medical Information is disclosed for the following purposes:

    • To third party health benefit providers and insurance companies where the patient has submitted a claim for reimbursement or payment of all or part of the cost of dental treatment or has asked us to submit a claim on the patient’s behalf

    • To other dentists and dental specialists where we are seeking a second opinion and the patient has consented to us obtaining the second opinion

    • To other dentists and dental specialists if the patient, with their consent, has been referred by us to the other dentist or dental specialist for treatment

    • To other dentists and dental specialists where those dentists have asked us, with the consent of the patient, to provide a second opinion

    • To other health care professionals, such as physicians, if the patient, with their consent, has been referred by us to the other health care professional for either a second opinion or treatment

    If we are ever considering selling all or part of our dental practice, qualified, potential purchasers may be granted access, as part of the due diligence process, to patient information in order to verify information important to the potential sale. If this occurs, we will take steps to ensure that the prospective purchaser safeguards all personal information.

    Dentists are regulated by the Alberta Dental Association and College, which may inspect our records and interview our staff as part of its regulatory activities in the public interest.




    YOUR DENTAL PLAN INFORMATION




















    PAYMENT OPTIONS

    LifePath Dental & Wellness is pleased to offer you the following payment options.

    Option 1: Payment is due in full the day treatment is rendered. We accept cash, cheque, debit, Visa, MasterCard, American Express, and E-transfers (accounts@lifepathwellness.com)

    Option 2: Your insurance company may require you to, or you may prefer to, pay for your dental work directly on your treatment day and have your insurance company reimburse you. LifePath Dental & Wellness will process your payment on the date treatment is rendered. Our team members will assist you in submitting the necessary documents to your insurance carrier.

    Option 3: You may leave your credit card number on file, and we will directly bill your insurance company; you do not have to wait around on your treatment day. Once your insurance company has paid us their portion, our Financial Advisors will process your patient portion to the credit card on file and email you your receipts. LifePath Dental & Wellness will provide estimates when requested.







      PATIENT RECORDS REQUEST





      to Chestermere Lifepath Wellness, Ltd. located at the above-noted address.

      I represent that I have legal authority to authorize the release of records requested. I understand that the information in my/my minor child’s health record may include, but is not limited to, information related to my/my minor child’s physical, behavioral, or mental health conditions previously disclosed.

      If you have questions about the disclosure of the requested records, please contact Chestermere Lifepath Wellness, Ltd. at (403) 235-6208.





      We look forward to hearing from you soon!

      Call us at (403) 235-6208 to book your
      New Dental Patient Consultation with us today!

      Lifepath Dental Welcomes Families Graphic | Chestermere Lifepath Dental | Lifepath Dental & Wellness

      New Patients, Families, And Friends Are Always Welcome. No Referral Is Required!

      Lifepath Dental Welcomes Families Graphic | Chestermere Lifepath Dental | Lifepath Dental & Wellness

      We serve the areas of Chestermere, Rainbow Falls, East Chestermere, Kinniburgh, The Cove, Calgary, SE Calgary, NE Calgary, Easthills, Langdon, Gleichen, Indus, Carseland, Bassano, Strathmore, Brooks, Suffield, Medicine Hat, Drumheller and surrounding areas.

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