Frick & Jones Periodontics is now Piedmont Periodontics. Same great team with a new name. 

Patient Forms

New to our office? Save time before your appointment by printing and filling out the forms below.

If you have any questions about these forms, please contact us or call us at 864-576-5951.

Payment Options

Our Financial Policy

We are committed to providing you with the best possible care and are pleased to discuss our professional fees with you at any time. Your clear understanding of our Financial Policy is important to our professional relationship. Feel free to ask about our fees, Financial Policy, or your responsibility.

If You Have Insurance:

Dental insurance is a contract between you and your insurance company. It is your responsibility to understand the extent and limits of your coverage, and to provide our staff with accurate information to process your claim efficiently (i.e. insurance company address, phone number, etc.) It is not our place to enter into disputes between you and your insurance company regarding deductibles, copayments, etc. other than to provide factual information. We do not directly participate with most insurance programs; however, as a courtesy, we do process your claim for payment to be made directly to you. Certain conditions may apply to your financial arrangements that may require your authorization for release and assignment of benefits. If we do not participate with your insurance, 100% of the total cost is requested at the time of treatment. If you are unable to pay 100%, affordable payment options are always available.

Our staff will help you process whatever paperwork is required; however, the ultimate responsibility lies with you for payment of any and all monies due.

Make a Payment

At Piedmont Periodontics we try to make paying your bill as convenient as possible by allowing you to pay online, over the phone, by mail, or in person.

Financing Options

Piedmont Periodontics & Implant Dentistry is a CareCredit certified provider. CareCredit is a healthcare credit card designed for your health and wellness needs. Click the links below to learn more about the payment flexibility CareCredit can offer, apply online, OR make a CareCredit payment.