New Patient Forms

Fill Out Forms Directly in the Browser (Easiest and Most Convenient):

New Adult Patient:

New Child Patient:

Alternatively, we have made our new patient forms available to you as Adobe Acrobat files which you can print and complete at home then bring to your appointment.

If you need any assistance please call Courthouse Art of Dentistry office at 703-260-9600.

Financial Information

Courthouse Art of Dentistry accepts most dental insurance. Please call our Arlington dental office for details at 703-778-0854. Dental insurance can be confusing, but we'll make it easy for you. Simply bring your card or claim into our office, or call to speak with our friendly insurance assistant. We participate as preferred providers with the following insurance companies: Aetna, Cigna, CareFirst BCBS, Delta Dental, Guardian, MetLife, and Principal. We also accept out of network benefits from any other insurance company. As a courtesy, we will file your insurance claims on your behalf.


About Dental Insurance

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.

For the most part, dental insurance covers preventive procedures, including annual X-rays, two cleanings and checkups per year, and fluoride treatments at 100 percent. Restorative care, such as fillings, crowns, replacement teeth, orthodontics, etc. are partially covered.

Cosmetic treatment is not covered. To help with this problem, we work with third party financing companies to make dentistry affordable for virtually all of our patients.

Most dental insurances also carry a "missing tooth clause." The clause states that your insurance will not pay for replacement of a tooth or teeth that were missing before your policy began. Our third party financing companies can help you afford dental implants, partials, dentures, or bridgework.

Your benefits are probably based on "usual, customary, and reasonable fees." These fees may not accurately reflect the cost of our services. We are not a clinic, and we offer many luxuries and technologies to make your dental care experience comfortable. We invest time with each of our patients. To us, you are a person, not a number or a chart. Our team invests in more continuing education than is required so that we can bring you the best dental care possible. The fees considered reasonable and customary by your insurance provider probably do not reflect the type of care and service we consider standard.

Your "yearly maximum" is the amount your insurance company will pay in a calendar year. Usually, the amount is $1000. If you do not use all of your yearly maximum before December 31st, you lose it. Each new calendar year, your maximum will fund again.

If your insurance provider does not pay their estimated portion, we will bill you for the balance. However, our insurance specialist will provide all paperwork, charts, X-rays, and photos necessary to optimize your benefits when we file your claim.


Methods of Payment

  • Cash
  • Mastercard
  • Visa
  • American Express
  • Discover
  • CareCredit
credit cards