Accepting New Patients Dental Emergencies Welcome

Patient Forms

For your convenience and to save time, you may download, print and fill out the following forms to bring with you to your first visit.

Download the HIPAA Privacy Act notice

Download the Registration Form

Download the Privacy Act Signature form


We accept most dental insurance plans and will gladly process your claim. We are happy to see those to whom we are a preferred provider and those who may be out of network and will work with you to get the most benefits out of your coverage. Please bring your insurance card or information and I.D. with you to your appointment. If you have questions about your insurance, feel free to give us a call at 276-676-2616. Financing is also available through CareCredit


Financing Available

Payment or insurance co-pay is expected on the day of service unless prior arrangements have been made. For your convenience we offer the following methods of payment: *Cash/Check *Visa *Mastercard *Discover *AmEx *CareCredit If you have questions concerning our financial arrangements, it will be our pleasure to assist you. If you would like to make a payment over the phone, please call 276-676-2616 You may pay your bill online by going to . Login or register first, then enter office statement code: W6XCUC. To make a payment through CareCredit, click on the link below.

Referral Program

We want to thank all of our existing patients for your support. Your referral of a friend, family member or co-worker is one of the greatest compliments our office could receive. Some of our best patients come from our wonderful existing patients, so if you are happy with us, we encourage you to tell your friends, family and co-workers about us. How our Patient Referral Program works: Simply tell people that you think would be interested in our services and have tell them to write your name in the referred by section on their new patient form. As a thank you we will be giving $20 gift cards for each person that you refer to us. There is no limit to the amount of referrals you can make. Any qualifying referral must be to someone who has never been a patient at our office. Rewards will only be given out after the new patients first appointment. Only one referring person per patient will be eligible for gift card. Gift cards will be for various restaurants, grocery stores, and other retailers and cannot be exchanged for cash. This offer starts on 9/4/2018 and expires on 12/16/2019. *Federal law prohibits us from offering this promotion to anyone who is receiving services as beneficiaries under Medicare or State Health Programs.

Dental Care Membership Program

Download Dental Care Membership Information

We are pleased to announce that we now offer a Dental Care Membership Program to all of our patients that do not have dental insurance. If you do not have insurance this plan is designed to provide affordability and easy access to quality dental care. Included in your annual membership fee are the following services:

● 2 exams

● Oral cancer screening/exam

● All needed x-rays

● 2 professional cleanings per year

● An emergency exam or consultation (if needed)

● 2 fluoride applications per year (child plan)

● Plus - a 15% discount on any additional regular priced treatment with cash or check, or 13% discount when paid by credit card. (Payment must be made day of service. Discount will not apply if using CareCredit)

Plus, there are:

● No waiting periods

● No annual maximums

● No deductibles

● No exclusions for cosmetic or elective care

This is not dental insurance . It is a wellness program for exclusive use at Gregory Owens, DDS . Contact our office today if you’d like to learn more, or if you would like to schedule your initial appointment. 276-676-2616 Annual pricing for plans:

● Adult Membership - 13 & older $275.00 - savings of $74.00 per year - not including discounts received for other treatment-if needed. ($124.00 for a new patient.)

● Child Membership - ages 6- 12 $250.00 - savings of $133.00 per year - not including discounts received for other treatment-if needed. ($166.00 for a new patient.) Gregory Owens, DDS Dental Care Membership Program

● Your membership is effective immediately after annual dues are paid ● Dental Care Membership will expire one year from date membership is taken out and membership will be up for renewal at this time. A renewal statement with annual charges will be sent out one month before renewal date. It is your responsibility to keep your mailing address updated so that you will receive your statement.

● Payment for additional treatment is required day of service to be eligible for discount.

● Membership may be cancelled at any time, however, refunds will not be provided for dues paid under any circumstances, including failure to schedule and maintain appointments.

● Your membership program is solely with our office and is non-transferrable. If you move to another area, you may cancel your membership at any time.

● Sometimes it is necessary to refer to a specialist, the specialist will charge you the fee that they have set for their practice. No discount will apply.

● Due to insurance regulations this membership program is only offered to our patients with no insurance or those who elect not to use their dental insurance. (this also excludes workers compensation and auto medical)

● If you are a patient that requires more than 2 professional cleanings per year, we will only charge for additional professional cleaning (no exam fee) and you will be able to apply discount to any additional cleaning visits as well. (Example 3-4 month wellness recall patients)

Legal & Disclaimers
Membership plans are not insurance but a payment arrangement provided by Gregory D Owens, DDS for services rendered. Memberships are provided exclusively to uninsured patients of our practice and shall not be considered pre-payment for future services or payment for access to discounted services. Rather, our patient members are electing to make regular annual subscription payments for preventive care instead of paying at the time of each service. Payment for any treatment is due at the time of service. Membership dues must be current in order to receive services. A lapse of 28 days in dues will require a reactivation fee of $99. Membership club discounts may not be combined with any other offers or discounts. It is solely the patient’s responsibility to schedule and keep their appointments. No refunds will be provided for dues paid under any circumstances, including failure to schedule and maintain appointments. A patient member’s annual agreement is with the legal entity of Gregory Owens, DDS . Annual dues and fees for dental services may change at any time.


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