New patient Forms (ENGLISH).pdf
New Patient Form (Japanese).pdf
Translation in German, French, Spanish, Chinese, Italian, Russian, Danish, Dutch, Greek, Polish
United Dental Office does not accept Japanese National Health Insurance. Please do not request an appointment if you would like to use Japanese National Health Insurance. Our fee for Limited Exam is JPY16,000 and we will need other necessary x-rays and oral photoes to give you accurate diagnosis and do any treatment.
The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete an online appointment request. We will need to have an e-mail address where we can remind you of the appointment and a mobile phone number where we can get in touch with you. If you have Cigna, Allianz, or Globality DKV, please send us the photo of both side of your insurance card by mail, so we can verify your eligibility before you arrive. We will hold your appointment for 15 minutes. You will receive appointment reminder through mail. Please press the Confirm bottom or let us know to change your appointment. (Click here to see Sample Reminder Mail Image)
Please bring with you
- Valid Picture ID
- Any Cigna, Allianz, DKV insurance information/card.
- A valid credit card or cash to make payment
If you are a new patient to our office, the attached file contains our new patient bundle with forms that will need to be filled out when you arrive at our office. Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival. Please call our office if you have any questions at all. Our New Patient Forms are also translated into German, French, Spanish, Chinese, Italian, Russian, Danish, Dutch, Greek, Polish
New Patient Form English .pdf
New Patient Form Japanese.pdf
Translation in German, French, Spanish, Chinese, Italian, Russian, Danish, Dutch,Greek, Polish
For your convenience, we accept cash, and most major credit cards. Payment is expected at the time services are performed.
We do NOT accept Japanese National Health Insurance. We provide fee-for-service treatment. Please refer to FAQ for the cost of examinations and treatment.
We accept direct payment for the following international health insurance companies.
We can claim directly, but the patient is responsible for any balance. If you want us to do direct claim for you, you must agrees to leave Credit Card Information to allow us to deduct any balance not paid by the insurance company. Patient not residing in Japan or leaving soon will need to pay in full before the start of treatment and claim themselves.
For all other type of insurances, we will try to help patient to fill the forms. All our forms and receipt are in English and coded with ADA codes.
Educational Dental Videos
Because we are committed to improving the oral healthcare knowledge of our patients, we are providing the following selection of dental videos which we hope you will find interesting and informative. We have grouped the videos into various categories to provide quick access to the topics of greatest interest to you.
Click Here to watch our series of educational dental videos!
United Dental Office® is a Registered Trademark of Wayukai Medical Corp.