Insurance, Payments, & Patient Forms for your Port Lavaca TX Dental Office

Port Lavaca TX Dentistry knows your time is valuable and aim to give you the best dental experience at our offices in a timely manner. To assist us in meeting this goal, we request registration forms be completed prior to your dental appointment. Please select the link below to access our registration forms. We also ask the following be brought with you to your appointment:
  • Completed Registration Forms
  • Drivers License and/or Valid ID
  • Insurance Cards (if any)
  • Current List of Medications
  • Current List of Physicians and/or Specialist Seen


New Patient Form - English

New Patient Form - Spanish


Notice of Privacy Practices - English

Notice of Privacy Practices - Spanish





The Priority Dental Plan gives patients a flexible alternative to dental insurance so your overall oral health doesn't have to suffer without the proper, professional care. For more information on Priority Dental Plan and payment options, Click Here.

Our office accepts most commercial dental insurances and Medicaid. If you have any questions regarding your insurance benefits please do not hesitate to call; we will be happy to review your concerns.

Please remember you are fully responsible for all fees charged by this office regardless of your insurance coverage. We accept insurance as a courtesy to our patients and try to estimate coverage to the best of our abilities. Please keep in mind plan coverage changes regularly. The treatment plan we present to the patient is only an estimate of coverage and not a guarantee of payment.

Major credit cards, cash, check and Care Credit are accepted in our office. If you are interested in applying for Care Credit, please click on the icon below to apply online.

Appointment request

Need an appointment with a dentist in Port Lavaca ? Requesting an appointment at our Port Lavaca, TX family and cosmetic dental office is now easier than ever. Fill out the form below and we'll contact you to find a time that fits your schedule. Start your journey towards a beautiful smile with us today!
Patient Name*
Phone Number*
Email Address
Are you a current patient?
Best time(s) to call?
Preferred Appt Date
Preferred Appt Time
Describe the nature of your appointment or any other comments