Patient Registration Form Patient Details

Patient Registration Form Contact Information



Patient Registration Form Responsible Party's Information

Patient Registration Form PRIMARY DENTAL INSURANCE

Patient Registration Form SECONDARY INSURANCE

Patient Registration Form Emergency Contact Information

Patient Registration Form Financial policy


At Parkway Dental Group, Wade Ahwal DDS MPH, our ultimate goal is your dental health and wellness.

We currently accept a large number of PPO insurance plans. This means we work with literally hundreds of companies. Although we can maintain computerized histories of payments by a given company, they do change; therefore it is impossible to give you a guaranteed quote at the time of service. We estimate your portion based on the most up-to-date information we have but it is ONLY AN ESTIMATE. If you would like exact out of pocket figures, we can submit a "pre-treatment authorization" with your insurance company. Keep in mind this is not a guarantee of coverage and it may delay treatment.

Your dental benefits are based upon a contract made between you and an insurance company. If you have any questions regarding your dental benefits please contact your employer or insurance company directly. Dental benefit plans will never pay for completion of your dental care. They are meant only to assist you.

We will bill your insurance company as a courtesy. If insurance does not pay within 90 days, Parkway Dental Group, Wade Ahwal DDS MPH reserves the right to request payment in full for services from you and let you collect the insurance funds due to you. This is rare, but it is important that you recognize that the insurance you have is a legal contract between YOU and your insurance company. Our office is not, and cannot be a part of that legal contract. Ultimately, you are responsible for all charges incurred in our office.

We accept MasterCard, Visa, American Express, Discover, cash, and checks. If you are in need of payment plans, we also work with CareCredit which offers 6 or 12 month "same as cash" no interest financing. Our staff can assist you in the application process.

  •  I have read and agree with the above conditions and office Policy.



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8881 Fletcher PKWY STE 265
La Mesa CA 91942
T:  (619) 463-1113
F:  (619) 463-1249