Patient Forms

Patient Forms

How to prepare for your first visit 

Complete the Health History and Office Policy form if you've received it in the mail. Please review these forms carefully.  You may also download a .pdf copy (at the bottom of the page).  If you do not have time to complete the forms at home, we ask that you arrive 10-15 minutes prior to your appointment time.

Contact your previous dentist and ask them to forward any recent x-rays to

Please, provide us with your insurance and identifying information in advance (48 hours, business day notice is suggested).  As a courtesy to our prospective patients, we volunteer to verify insurance benefits. This helps to give the patient an idea what the policy covers before incurring any charges. Dental plans usually put 'frequency limitations' on routine procedures. When we check benefits, we are also verifying any recent history of x-rays, exams and cleanings which may result in a higher out of pocket expense for the patient. Sometimes this can be as simple as a quick phone call. Other times, it can be a process of fax transmittals and online requests. So, we find that 48 hours is usually enough time to verify and research your benefit plan. 

Patient Forms

This web site uses files in Adobe Acrobat Portable Document Format  (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

Payment Options

For your convenience, we accept cash, personal checks, money orders and major credit cards. Payment is expected at the time services are performed. When more extensive dental care is necessary, financial arrangements can be made with our office.

Payment Options

For your convenience, we accept cash, personal checks, and most major credit cards. Payment is expected at the time services are performed. Feel free to contact our office If your treatment plan requires more comprehensive dental work and you want to discuss financial arrangements.



Dental Insurance

Please contact our office for Insurance details.  We look forward to hearing from you.


As a service to our patients, our practice accepts most dental insurance programs, including non-managed care, indemnity (traditional) and PPO out-of-network.  We are not part of any managed care network.  Our accounting team will prepare all the necessary forms for your dental benefits. However, we remind you that your specific policy is an agreement between you and your insurance company. Please keep in mind that you are responsible for your total obligation should your insurance benefits result in less coverage than anticipated. Our team will gladly submit a pre-treatment estimate to your insurance company so that you will know what your benefits will be.

The fees charged for services rendered to those who are insured are the usual and customary fees charged to all our patients for similar services. Your policy may base its allowances on a fixed fee schedule, which may or may not coincide with our usual fees. You should be aware that different insurance companies vary greatly in the types of coverage available. Also, some companies take care of claims promptly while others delay payment for several months.

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Quality professional team members that pride ourselves in furthering education to ensure you get the quality care you deserve.

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2608 Concord BlvdConcord, CA 94519-2605Get Directions(925) 685-5764

Concord Dentist, Dr. Elizabeth Nichols is dedicated to cosmetic dentistry such as Exams, Teeth Whitening, Veneers and more. We are looking forward to your visit to our Concord, California dental office.

2024 Elizabeth B Nichols, DDS
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