Call To Book An Appointment

Location

3007 Ridgeline Blvd.
Suite A Tarpon Springs

Days We Are Open

Monday - Saturday
Sunday Closed

Call Now To Book Appointment

(727) 787-6453

New Patient Form

Fill out the form below or click this link to download the form.

Understanding Your Dental Benefits

We are committed to your treatment being successful. Please understand that payment of your bill is considered part of your treatment. The following is a statement of your Dental Benefits that we require you read and sign prior to treatment.

We Gladly File Your Insurance

Your insurance policy is a contract betw,een you and your insurance company. It is important to know that professional services are rendered and charged to you, the patient.

It is our responsibility to provide the utmost quality care. Diagnosis and treatment are determined by your Doctor, not your Insurance Company. Our obligation is to help you as much as we can by completing all forms pertaining to your claim and submitting them promptly to your company. This helps you obtain the reimbursement you are entitled to receive as quickly as possible.

Because different Insurance Companies reimburse the office at their own “Usual and Customary Fee” rates (which may be lower than ours), there will be an In-Office Co-Pay for each visit of treatment to you, the patient. Should your total treatment be covered under your plan, our office will reimburse you, or add the credit to your account after the Insurance Coverage has been received.

As your doctor may be a “Provider” on your Particular Plan, this does not mean that each visit is covered at 100%. Not all dental services may be covered under your particular plan (ie Crowns, Gum Disease Treatment, and/or White Fillings). You may be obligated to pay the additional fee that your Insurance does not cover. At your request, we are willing to send a Pre­-Determination to your Insurance Company before treatment so you have a greater understanding ofyour financial responsibilities.

Please Research your Insurance Company before your visit with us, so that we are able to serve you and answer any questions you may have. If there is a question about your Insurance Payment, or non-payment, we will be happy to assist you as much as we can, but the question and answers also should be directed to your particular Insurance Company. The more information the company receives, the greater chance the industry will change.

Thank You for understanding our Benefit Options. Please let our receptionist know if you have any questions or concerns.

I have read, understand, and agree to the provisions of these Benefit Options. In the event of defaults in the payment of arrangements made, and if these arrangements are placed in the hands of an attorney at law for collection, the undersigned hereby agrees to pay all costs of collection including a reasonable attorney’s fee. Presentment protest and notice are hereby waived.

1575653424_New Patient Form2

SECTION A: PATIENT GIVING CONSENT

SECTION B: TO THE PATIENT - PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY

PURPOSE OF CONSENT: By signing this form, you will consent to our use and disclosure if your protected health information to carry out treatment, payment activities, and healthcare operations.

NOTICE OF PRIVACY PRACTICES: You have the right to read our Notice of Privacy Practices before you decide whether to sign this consent. Our Notice provides a description of treatment, payment, and healthcare operations, of the uses and disclosures we may make of your protected health information, and of other important matters about your protected health information. A copy of our Notice Accompanies this Consent. We encourage you to read it carefully and completely before signing this Consent.

We reserve the right to change our privacy practices as described in out Notice of Privacy Practices. If we change our privacy practices, we will issue a revised Notice of Privacy Practices, which will include the changes. Those changes may apply to any of your protected health information that we maintain.

You may obtain a copy of our Notices of Privacy Practices, including any revisions of our Notices, at any time by contacting:

Expressions Cosmetic & Family Dentistry
Dr. Lyndsay H. McCaslin
3007 Ridgeline Blvd, Suite A
Tarpon Springs, FL 34688
Phone: 727-787-6453
Email: Expressionsdentistry@yahoo.com

RIGHT TO REVOKE: You will have the right to revoke this consent at any time by giving us written notice of your revocation submitted to the Contact Person listed above. Please understand that revocation of this consent will not affect any action we took in reliance on this Consent before we received your revocation, and that we may decline to treat you or continue to treat you if you revoke this Consent.

I have had full opportunity to read and consider the contents of this Consent form and your Notice of Privacy Practices. I understand that, by signing this Consent form, I am giving my consent to your use and disclosure of my protected health information to carry out treatment, payment activities, and healthcare operations.

If a personal representative on behalf of the patient signs this consent, complete the following:

** YOU ARE ENTITLED TO A COPY OF THIS FORM AFTER YOU SIGN IT**

Patient History and Information

Please answer the following questions.

Dental History

Teeth Appearance

Medical History

Although dental personnel primarily treat the area in and around your mouth, your mouth is a part of your entire body. Health problems that you may have, or medication that you may be taking, could have an important interrelationship with the dentistry you will receive. Thank you for answering the following questions.


Women: Are you:

Allergies - Check all that apply

Pre-existing Conditions

Acknowledgement and Authority

I consent to treatment as necessary or desirable to the care of the patient first named above. Including, but not limited to whatever drugs, medicine, performance of operations and conduct of laboratory, x-ray, or other studies that may be used by the attending doctor, or his nurse of qualified designate. I also acknowledge full responsibility for the payment of such services and agree to pay for them, in full, AT THE TIME OF SERVICE, unless other arrangements are made with the Financial Department. In the event of Default, the undersigned applicant agrees to pay interest at the rate of 1 1/2 % per month on any outstanding balance (18% Annual Interest). In addition, the undersigned applicant agrees to pay all court costs and attorney's fees reasonably necessary for collections, including attorney fees on appeal.

Your Financial Options

Thank You for selecting us as your dental health care provider

We are committed to your treatment being successful. Please understand that payment of your bill is considered part of your treatment. The following is a statement of your financial options that we require you to read and sign prior to treatment
  • Full payment is due at the time of service unless other arrangements have been made. We graciously accept Cash, Checks, Visa, MasterCard, Discover and American Express
  • For Patients with comprehensive treatment plans, we offer a definitive payment plan for 3 months with no interest
  • We offer extended payment plans with prior credit approval by outside lending organizations such as:
    • Fifth Third: 12 months interest free; with no processing fee.
    • Care Credit: 12-18 months interest free, with a processing fee that will be calculated to 7% your total comprehensive treatment plan.
We gladly file your insurance

Your insurance policy is a contract between you and your insurance company. It is important to know that professional services are rendered and charged to you, the patient. Because different insurance companies reimburse the office at their own “Usual and Customary Fee” rates, there will be an In-Office co-pay for each visit of treatment to you, the patient. Should your total treatment be covered under your plan, our office will reimburse you, or add a credit to your account after the Insurance Coverage has been received.

Not all dental services may be covered under your particular plan. Diagnosis and treatment are determined by your doctor, not your insurance company. Our obligation is to help you as much as we can by completing all forms pertaining to your claim and submitting them promptly to your company. This helps you obtain the reimbursement you are entitled to receive as quickly as possible.


Minor Patients
The parent or guardian accompanying a minor is responsible for the full payment regardless of any insurance coverage through a divorced parent situation. For unaccompanied minors, non- emergency treatment will be denied unless charges have been pre-authorized to an approved credit plan, Visa, MasterCard, Discover, or payment by Cash or Check at the time of service.

Thank you for understanding our financial options. Please let our receptionist know if you have any questions or concerns.

I have read, understand, and agree to the provisions of these Benefit Options. In the event of defaults in the payment of arrangements made, and if these arrangements are placed in the hands of an attorney at law for collection, the undersigned hereby agrees to pay all costs of collection including a reasonable attorney’s fee. Presentment protest and notice are hereby waived.

Keeping your Scheduled Appointments are Very Important at our Office

Unless cancelled at least 24 hours in advance WEEKDAY, and at least 48 hours in advance for SATURDAY there will be a fee for missed appointments at the rate of a $50 per hour of time. Please help us serve you better by keeping all scheduled appointments. Keeping your Scheduled Appointments are Very Important at our Office … Unless cancelled at least 24 hours in advance WEEKDAY, and at least 48 hours in advance for SATURDAY there will be a fee for missed appointments at the rate of a $50 per hour of time. Please help us serve you better by keeping all scheduled appointments.

VELscope Agreement

Did you know that one America dies from Oral Cancer every hour?

In 2013, Dr. McCaslin's mother, Becky, was one of these victims - and we want to prevent this tragedy for you and your family.

Tobacco, Alcohol, and the HPV virus are considered major pre-disposing risk factors to Oral Cancer, but more than 25% of oral cancer victims have no such lifestyle risk factos. For this reason, we believe that all individuals over the age of 18 should have an annual Comprehensive Oral Exam.

At our office, we have incorporated the VELscope Oral Cancer Screening System. This 3 minute exam has been cleared by the FDA and is used to assist Dr. McCaslin, and her hygienists in detection cancerous and pre-cancerous growths that may not appear to the naked eye.

This screening is completely pain free, and is affordably priced. At approximately $19 (which may or may not be covered by insurance), isn't it worth the peace of mind?

YES! I would prefer to have the VELscope Oral Screening at this time.

No... I would prefer NOT to have the VELscope Oral Screening at this time.

Testimonials

“Dr Lyndsay McCaslin is Honestly one of the best dentists I have ever had! I appreciate her recommendations for any extra care I may need to pay attention and adhere too upon and after an examination. In addition the hygienist are very thorough, knowledgeable, friendly and understanding as well. I have actually always enjoyed going to the dentist but for people who do not look forward to their dental exams might feel better about it if they come here.”

Testimonials

"I absolutely love expressions dentistry!! They have the best chair side manners for a dentist office. They are as gentle as need be. My children absolutely love this office, They have no fear of dentist offices anymore! They are by far the best dentist office in Pinellas County. The whole staff is amazing!! I’m so comfortable in this office, I fell asleep 2 different times while she was doing all the work in my mouth!"

Testimonials

"I went for my routine dental checkup which included xrays and cleaning. From the time I entered the office to the time I left all staff was friendly and helpful. The hygienist was friendly, gentle, and explained everything before it was performed. The dentists came in and reviewed the xrays with me and future treatments in an understandable manner. I would recommend this dentist to all my friends and family as one of the best!"

Testimonials

"What a wonderful experience. I have never been to a dental office like this. I’m not sure I could go back to the “old” way. The staff were absolutely charming. I loved the dentist. She explained the reasons behind the dental changes I had and the treatment. I didn’t feel like a number, even though it was my first visit. I felt like I had been going to that office for years. I actually look forward to my next visit. Who says that about the dentist? Definitely will refer to everyone I know."

Testimonials

"Not something you expect to hear about a visit to the dentist, but the efficiency and professionalism of Lindsay McCaslin and her staff, from assistants to the front office, made what could have been an ordeal a relatively pleasant experience."

New Patient Special

Exam, X-ray and Cleaning – $159