Bethesda-Chevy Chase Root Canal Specialists, LLC
Practice Limited to Endodontics
Thank you for contacting our office, and welcome to our practice. Please complete the following registration form prior to your appointment.
In addition, please follow these guidelines in preparation for your visit:
1) Please bring your referral information and x-rays, if any, from your restorative dentist.
2) Eat breakfast or lunch before your appointment to ensure a normal blood glucose level. DO NOT drink caffeinated drinks, such as regular coffee.
3) Arrive 10 minutes early to complete a few additional forms. Bring a complete list of all medications and dosages with you.
4) Take all of your routine medications, including aspirin therapy, if applicable. However, do not take medication for discomfort (i.e., ibuprofen, Advil, Motrin, Aleve, Tylenol, etc.) prior to the first visit because it may mask symptoms and hinder diagnosis.
5) If you require prophylactic antibiotics before dental visits for a prosthetic heart valve or orthopedic prosthesis (artificial hip, knee, elbow, etc.), please call our office for instructions. If you've already discussed this with us, you do not need to call again.
6) Please let us know if you take Coumadin (warfarin sodium), so we can contact your physician in advance to receive your current INR readings.
7) Our office hours are from 8:30 am until 5:00 pm, Monday-Friday. Occasionally, last minute emergency patients can delay our schedule, so please allow a little extra time for your appointment. We value your time and will try to keep you updated when delays occur.
8) All patients under the age of 18 must be accompanied on each visit by their parent or legal guardian.
9) Please explore our website to learn more.
10) Insurance: Endodontic fees are based on the complexity of the procedures. We will make every effort to help you get reimbursed by your insurance carrier, so please bring your dental and medical insurance information with you. Drs. Jong, Mischenko and Lee participate with a select group of insurance carriers. We welcome any questions you may have about payments and insurance benefits.
Patient Registration and Health History Form