Patient Forms

To get started, please fill out our new patient forms. We do tailor your appointment to your specific needs, so please make sure they are completed prior to your first visit.

Premium Out-of-Network Care

At Manyak Dental Group, we've intentionally chosen to remain out-of-network with dental insurance companies. This isn't a limitation—it's our commitment to providing unrestricted, premium care.

‍What this means for you: You pay for treatment at the time of service, and we file all insurance claims on your behalf. Your insurance company reimburses you directly based on your out-of-network benefits (typically 50-80% depending on your plan). Our team manages pre-authorizations, reviews your coverage carefully, and advocates for maximum reimbursement—we handle the paperwork so you can focus on your smile.

‍Why we choose out-of-network: Insurance networks often require dentists to use cheaper materials, rush through appointments to maintain high patient volume, and limit treatment options to the most cost-effective procedures. By remaining out-of-network, we're free to invest in advanced technology (like our Solea laser), spend unhurried time with each patient, and recommend what's truly best for your long-term oral health—not what satisfies an insurance company's bottom line

Premium Membership Plans—Comprehensive Care Without the Insurance Hassle

Choose a plan that fits your dental needs.

Our membership plans aren't typical discount programs—they're comprehensive care packages designed to match the premium quality of treatment we provide.Unlike basic dental plans that cover only cleanings and exams, our memberships include advanced cancer screenings (Velscope), unlimited emergency visits, fluoride treatments, and significant discounts on all procedures. No waiting periods. No claim denials. No annual maximums. Just predictable, transparent pricing for exceptional care.

‍Perfect for: Patients who value quality over cost, those with insurance plans that don't cover comprehensive care, or anyone tired of insurance bureaucracy.

Child Plan

Child (Age 1-12)

$532/yr

2 Prophylaxis Appointments
All Periodic, Comprehensive and Emergency Exams
Intra-oral Digital X-Rays**
Fluoride Treatments
Advanced Oral Cancer Screenings (Velscope)
20% Off Most Dental Procedures*
No deductibles, No Yearly Maximums, No Claim Forms, No Pre-Authorization, Immediate Eligibility

Most dental insurance plans cover only basic cleanings and exams for children. Our plan includes advanced cancer screenings and fluoride treatments standard insurance doesn't provide—plus 20% off all procedures without claim forms or coverage denials.
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*Percentage off regular list UCR fees; Invisalign & Specialists (Oral Surgeon, Perio, etc.) -- 10% off list UCR; Healthy Start excluded; may not be combined with other offers, promotions, discounts, or extended finance agreements

‍**Excludes panoramic x-rays

Adult Plan

Adult (Age 13+)

$864/yr

3 Prophylaxis Appointments
All Periodic, Comprehensive and Emergency Exams
Intra-oral Digital X-Rays**
Fluoride Treatments
Advanced Oral Cancer Screenings (Velscope)
20% Off Most Dental Procedures*
No deductibles, No Yearly Maximums, No Claim Forms, No Pre-Authorization, Immediate Eligibility

Typical dental insurance covers 2 cleanings per year. Our plan includes 3 cleanings, advanced cancer screenings, and comprehensive preventive care—all without deductibles, claim forms, or yearly maximums.
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*Percentage off regular list UCR fees; Invisalign & Specialists (Oral Surgeon, Perio, etc.) -- 10% off list UCR; Healthy Start excluded; may not be combined with other offers, promotions, discounts, or extended finance agreements

‍**Excludes panoramic x-rays

Perio Plan

For patients requiring periodontal therapy

$1,368/yr

4 Periodontal Maintenance Appointments
All Periodic, Comprehensive and Emergency Exams
Intra-oral Digital X-Rays**
Fluoride Treatments
Advanced Oral Cancer Screenings (Velscope)
20% Off Most Dental Procedures*
No deductibles, No Yearly Maximums, No Claim Forms, No Pre-Authorization, Immediate Eligibility

Insurance often limits periodontal care to 2-3 visits per year. Our plan includes 4 specialized maintenance appointments plus comprehensive preventive care—designed for patients who need more than basic coverage provides.
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*Percentage off regular list UCR fees; Invisalign & Specialists (Oral Surgeon, Perio, etc.) -- 10% off list UCR; Healthy Start excluded; may not be combined with other offers, promotions, discounts, or extended finance agreements
**Excludes panoramic x-rays

Flexible Financing

Get the care you need while staying in your budget. We offer CareCredit, a flexible monthly payment option that allows you to pay for treatment with options that suit your lifestyle needs.

Patient Resources