What To Expect During Your Visit

During your first visit, you will receive a comprehensive exam to determine an appropriate plan to achieve the best possible oral health. Dr. Low will go through your medical history and discuss any conditions or medications that may affect your dental care as well as possible dental treatments. In addition, charting (odontogram and periodontal), an oral cancer screen, and X-rays where applicable will be completed. Based on all the gathered information, you will be provided multiple treatment options, taking both treatment outcomes and financial impacts into consideration.

Ask questions! Our job is to make you comfortable and explain all the options available. We want to ensure you are well informed.

New Patients

Please fill out the new patient form, place it in a sealed envelope, and bring it to your next appointment.

Fill Out This Form

Please fill out all fields that apply.

New Patient Form

Dental Insurance

Due to the privacy act, most dental insurance companies will not divulge dental information to dental offices. It is in your best interest that you keep us informed of your plan's limitations and any changes as soon as they occur as you are financially responsible for any dental services not covered by your plan's contract.

We are able to submit most claims electronically, but in order for us to do so, please sign the following:
I authorize, release to my dental benefits plan administrator & CDA, information contained in my claims submitted electronically. I also authorize the communication of information related to the coverage of services described by the named dentist.

The authorization shall continue in effect until the undersigned revokes the same.
I hereby assign my benefits payable from claims submitted electronically to Dr. Johnathan C. Low Inc. and authorize payments directly to him.

The authorization shall continue in effect until the undersigned revokes the same.


Your appointment time is reserved especially for you. If you are unable to keep your appointment, please let us know at least 48 hours in advance, so that we may give that time to another patient requiring dental work. You may leave a message on our voicemail if you are unable to reach us in person.

A minimum charge of $75 will be charged for a missed appointment or an appointment cancelled without the 48 hours notice.


Payment in full is expected on the day of your appointment for services rendered, unless previous financial arrangements have been made. Interest will be charged on unpaid account balances after 30 days.

Dental History

Do you have a specific, immediate concern? *
Do you have an anxiety or fear of dentistry? *
Have you ever had:
Are you concerned about any of the following:

Medical History

Please check the appropriate box if you have ever been diagnosed (recently or in the past) for any of the following:


Patient Signature

To the best of my knowledge, all of the preceding answers concerning my medical history are complete and accurate. If there is a change in my health or in the medication I may be taking, I will immediately notify my dental care provider at my next appointment.