{"id":2595,"date":"2020-12-22T18:09:02","date_gmt":"2020-12-22T18:09:02","guid":{"rendered":"https:\/\/idgpa.com\/?page_id=2595"},"modified":"2021-10-07T16:00:56","modified_gmt":"2021-10-07T16:00:56","slug":"new-patients-forms","status":"publish","type":"page","link":"https:\/\/idgpa.com\/new-patients-forms\/","title":{"rendered":"New Patient Forms"},"content":{"rendered":"<p><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 hundred-percent-fullwidth non-hundred-percent-height-scrolling fusion-equal-height-columns\" style=\"background-color: rgba(255,255,255,0);background-position: left top;background-repeat: no-repeat;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;margin-bottom: 0px;margin-top: 0px;border-width: 0px 0px 0px 0px;border-color:#eae9e9;border-style:solid;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_2 1_2 fusion-one-half fusion-column-first fusion-animated\" style=\"margin-top:0px;margin-bottom:0px;\" data-animationType=\"fadeInLeft\" data-animationDuration=\"1.0\" data-animationOffset=\"100%\"><div class=\"fusion-column-wrapper fusion-flex-column-wrapper-legacy\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 12% 17% 10% 17%;\"><div class=\"fusion-column-content-centered\"><div class=\"fusion-column-content\"><style type=\"text\/css\"><\/style><div class=\"fusion-title title fusion-title-1 fusion-title-text fusion-title-size-two\" style=\"font-size:35px;margin-top:0px;margin-bottom:30px;\"><h2 class=\"title-heading-left\" style=\"margin:0;font-size:1em;\">New Patient Forms<\/h2><div class=\"title-sep-container\"><div class=\"title-sep sep-\" style=\"border-color:#e2e2e2;\"><\/div><\/div><\/div><div class=\"fusion-text fusion-text-1\" style=\"transform:translate3d(0,0,0);\"><p>If possible, please print and fill out these forms and bring them with you to your appointment.<\/p>\n<\/div><div class=\"fusion-alignleft\"><style type=\"text\/css\">.fusion-button.button-1 .fusion-button-text, .fusion-button.button-1 i {color:#ffffff;}.fusion-button.button-1 .fusion-button-icon-divider{border-color:#ffffff;}.fusion-button.button-1:hover .fusion-button-text, .fusion-button.button-1:hover i,.fusion-button.button-1:focus .fusion-button-text, .fusion-button.button-1:focus i,.fusion-button.button-1:active .fusion-button-text, .fusion-button.button-1:active{color:#ffffff;}.fusion-button.button-1:hover .fusion-button-icon-divider, .fusion-button.button-1:hover .fusion-button-icon-divider, .fusion-button.button-1:active .fusion-button-icon-divider{border-color:#ffffff;}.fusion-button.button-1:hover, .fusion-button.button-1:focus, .fusion-button.button-1:active{border-color:#ffffff;}.fusion-button.button-1 {border-color:#ffffff;border-radius:2px;}.fusion-button.button-1{background: #2d3d4d;}.fusion-button.button-1:hover,.button-1:focus,.fusion-button.button-1:active{background: #2d3d4d;}.fusion-button.button-1 .fusion-button-text {text-transform:uppercase;}<\/style><a class=\"fusion-button button-flat fusion-button-default-size button-custom button-1 fusion-button-default-span fusion-button-default-type\" target=\"_blank\" rel=\"noopener noreferrer\" href=\"\/wp-content\/uploads\/2021\/01\/New-patient-form-.pdf\"><span class=\"fusion-button-text\">new patient forms<\/span><\/a><\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"margin-left: auto;margin-right: auto;margin-top:15px;margin-bottom:15px;width:100%;\"><\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-alignleft\"><style type=\"text\/css\">.fusion-button.button-2 .fusion-button-text, .fusion-button.button-2 i {color:#ffffff;}.fusion-button.button-2 .fusion-button-icon-divider{border-color:#ffffff;}.fusion-button.button-2:hover .fusion-button-text, .fusion-button.button-2:hover i,.fusion-button.button-2:focus .fusion-button-text, .fusion-button.button-2:focus i,.fusion-button.button-2:active .fusion-button-text, .fusion-button.button-2:active{color:#ffffff;}.fusion-button.button-2:hover .fusion-button-icon-divider, .fusion-button.button-2:hover .fusion-button-icon-divider, .fusion-button.button-2:active .fusion-button-icon-divider{border-color:#ffffff;}.fusion-button.button-2:hover, .fusion-button.button-2:focus, .fusion-button.button-2:active{border-color:#ffffff;}.fusion-button.button-2 {border-color:#ffffff;border-radius:2px;}.fusion-button.button-2{background: #2d3d4d;}.fusion-button.button-2:hover,.button-2:focus,.fusion-button.button-2:active{background: #2d3d4d;}.fusion-button.button-2 .fusion-button-text {text-transform:uppercase;}<\/style><a class=\"fusion-button button-flat fusion-button-default-size button-custom button-2 fusion-button-default-span fusion-button-default-type\" target=\"_blank\" rel=\"noopener noreferrer\" href=\"\/wp-content\/uploads\/2021\/01\/Missed-Appointment-Form.pdf\"><span class=\"fusion-button-text\">missed appointment form<\/span><\/a><\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"margin-left: auto;margin-right: auto;margin-top:15px;margin-bottom:15px;width:100%;\"><\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-alignleft\"><style type=\"text\/css\">.fusion-button.button-3 .fusion-button-text, .fusion-button.button-3 i {color:#ffffff;}.fusion-button.button-3 .fusion-button-icon-divider{border-color:#ffffff;}.fusion-button.button-3:hover .fusion-button-text, .fusion-button.button-3:hover i,.fusion-button.button-3:focus .fusion-button-text, .fusion-button.button-3:focus i,.fusion-button.button-3:active .fusion-button-text, .fusion-button.button-3:active{color:#ffffff;}.fusion-button.button-3:hover .fusion-button-icon-divider, .fusion-button.button-3:hover .fusion-button-icon-divider, .fusion-button.button-3:active .fusion-button-icon-divider{border-color:#ffffff;}.fusion-button.button-3:hover, .fusion-button.button-3:focus, .fusion-button.button-3:active{border-color:#ffffff;}.fusion-button.button-3 {border-color:#ffffff;border-radius:2px;}.fusion-button.button-3{background: #2d3d4d;}.fusion-button.button-3:hover,.button-3:focus,.fusion-button.button-3:active{background: #2d3d4d;}.fusion-button.button-3 .fusion-button-text {text-transform:uppercase;}<\/style><a class=\"fusion-button button-flat fusion-button-default-size button-custom button-3 fusion-button-default-span fusion-button-default-type\" target=\"_blank\" rel=\"noopener noreferrer\" href=\"\/wp-content\/uploads\/2021\/01\/Covid-Questionnaire.pdf\"><span class=\"fusion-button-text\">covid questionnaire<\/span><\/a><\/div><\/div><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_1_2 1_2 fusion-one-half fusion-column-last fusion-column-inner-bg-wrapper fusion-animated\" style=\"margin-top:0px;margin-bottom:0px;\" data-animationType=\"fadeInRight\" data-animationDuration=\"1.0\" data-animationOffset=\"100%\"><div class=\"fusion-column-wrapper fusion-flex-column-wrapper-legacy\" style=\"padding: 10% 0px 0px 0px;\" data-bg-url=\"https:\/\/idgpa.com\/wp-content\/uploads\/2021\/01\/AdobeStock_311198389.jpeg\"><div class=\"fusion-clearfix\"><\/div><\/div><span class=\"fusion-column-inner-bg hover-type-zoomin\"><a class=\"fusion-column-anchor\"><span class=\"fusion-column-inner-bg-image lazyload\" style=\"background-image:inherit;background-position:center top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;\" data-bg-image=\"url(&#039;https:\/\/idgpa.com\/wp-content\/uploads\/2021\/01\/AdobeStock_311198389.jpeg&#039;)\"><\/span><\/a><\/span><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-2 fusion-parallax-fixed nonhundred-percent-fullwidth non-hundred-percent-height-scrolling lazyload\" style=\"background-color: rgba(0,0,0,0.85);background-image:inherit;background-position: center top;background-repeat: no-repeat;background-blend-mode: overlay;padding-top:80px;padding-right:0px;padding-bottom:80px;padding-left:0px;margin-bottom: 0px;margin-top: 0px;border-width: 0px 0px 0px 0px;border-color:#eae9e9;border-style:solid;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;background-attachment:fixed;\"  data-bg-image=\"url(&quot;https:\/\/idgpa.com\/wp-content\/uploads\/2021\/01\/AdobeStock_229797701.jpeg&quot;)\"><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last fusion-column-no-min-height\" style=\"margin-top:0px;margin-bottom:0px;\"><div class=\"fusion-column-wrapper fusion-flex-column-wrapper-legacy\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 0px 0px 0px 0px;\"><style type=\"text\/css\"><\/style><div class=\"fusion-title title fusion-title-2 fusion-title-center fusion-title-text fusion-title-size-two\" style=\"font-size:70px;margin-top:0px;margin-bottom:40px;\"><div class=\"title-sep-container title-sep-container-left\"><div class=\"title-sep sep-\" style=\"border-color:#e2e2e2;\"><\/div><\/div><h2 class=\"title-heading-center\" style=\"margin:0;font-size:1em;color:#f44336;\"><p style=\"text-align: center;\">BOOK AN APPOINTMENT NOW<\/p><\/h2><div class=\"title-sep-container title-sep-container-right\"><div class=\"title-sep sep-\" style=\"border-color:#e2e2e2;\"><\/div><\/div><\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"margin-left: auto;margin-right: auto;margin-top:20px;width:100%;\"><\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-aligncenter\"><style type=\"text\/css\">.fusion-button.button-4 .fusion-button-text, .fusion-button.button-4 i {color:rgba(255,255,255,.8);}.fusion-button.button-4 .fusion-button-icon-divider{border-color:rgba(255,255,255,.8);}.fusion-button.button-4:hover .fusion-button-text, .fusion-button.button-4:hover i,.fusion-button.button-4:focus .fusion-button-text, .fusion-button.button-4:focus i,.fusion-button.button-4:active .fusion-button-text, .fusion-button.button-4:active{color:#ffffff;}.fusion-button.button-4:hover .fusion-button-icon-divider, .fusion-button.button-4:hover .fusion-button-icon-divider, .fusion-button.button-4:active .fusion-button-icon-divider{border-color:#ffffff;}.fusion-button.button-4:hover, .fusion-button.button-4:focus, .fusion-button.button-4:active{border-color:#ffffff;border-width:3px;}.fusion-button.button-4 {border-color:rgba(255,255,255,.8);border-width:3px;border-radius:2px;}.fusion-button.button-4{background: rgba(255,255,255,.1);}.fusion-button.button-4:hover,.button-4:focus,.fusion-button.button-4:active{background: rgba(255, 255, 255, 0.25);}.fusion-button.button-4 .fusion-button-text {text-transform:uppercase;}<\/style><a class=\"fusion-button button-flat button-xlarge button-custom button-4 fusion-button-default-span fusion-animated\" data-animationType=\"fadeInUp\" data-animationDuration=\"1\" data-animationOffset=\"100%\" target=\"_self\" href=\"https:\/\/www.localmed.com\/offices\/408ff5b7-a8e5-4fbe-91e5-d71d7d509a7f\/widget\/?chrome=&amp;hidePartnerLogo=true&amp;partnerId=&amp;referringWidgetId=614f1c51-33c5-47f2-9c0e-c525d12ef9e0&amp;scheduling=in_widget&amp;utm_campaign=button_widget&amp;utm_content=Independence%20Dental%20Group%20-%20google&amp;utm_medium=widget&amp;utm_source=www.google.com&amp;patientStatusId=&amp;reasonForVisitId=&amp;after=2024-03-06&amp;minDate=2024-03-06\"><span class=\"fusion-button-text\">Book An Appointment NOW<\/span><\/a><\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"margin-left: auto;margin-right: auto;margin-top:20px;width:100%;\"><\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-text fusion-text-2\" style=\"font-size:80px;color:#ffffff;transform:translate3d(0,0,0);\"><h2 style=\"text-align: center;\"><span style=\"color: #ffffff;\">No Insurance? No Problem<\/span><\/h2>\n<h3 style=\"text-align: center;\"><span style=\"color: #ffffff;\">New Patient Exam and Consultation <span style=\"color: #ff0000;\">$99<\/span> &#8211; Rolled into cost of treatment completed. Includes X rays and consultation with Dr. Gelbart to go over your unique treatment plan<\/span><\/h3>\n<h3 style=\"text-align: center;\"><span style=\"color: #ffffff;\">Just looking for a checkup and cleaning? <\/span><\/h3>\n<h3 style=\"text-align: center;\"><span style=\"color: #ffffff;\">New Patient Exam, X Rays and Regular Cleaning <span style=\"color: #ff0000;\">$198\u00a0<\/span><\/span><\/h3>\n<\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"margin-left: auto;margin-right: auto;margin-top:20px;width:100%;\"><\/div><div class=\"fusion-sep-clear\"><\/div><div class=\"fusion-aligncenter\"><style type=\"text\/css\">.fusion-button.button-5 .fusion-button-text, .fusion-button.button-5 i {color:rgba(255,255,255,.8);}.fusion-button.button-5 .fusion-button-icon-divider{border-color:rgba(255,255,255,.8);}.fusion-button.button-5:hover .fusion-button-text, .fusion-button.button-5:hover i,.fusion-button.button-5:focus .fusion-button-text, .fusion-button.button-5:focus i,.fusion-button.button-5:active .fusion-button-text, .fusion-button.button-5:active{color:#ffffff;}.fusion-button.button-5:hover .fusion-button-icon-divider, .fusion-button.button-5:hover .fusion-button-icon-divider, .fusion-button.button-5:active .fusion-button-icon-divider{border-color:#ffffff;}.fusion-button.button-5:hover, .fusion-button.button-5:focus, .fusion-button.button-5:active{border-color:#ffffff;border-width:3px;}.fusion-button.button-5 {border-color:rgba(255,255,255,.8);border-width:3px;border-radius:2px;}.fusion-button.button-5{background: rgba(255,255,255,.1);}.fusion-button.button-5:hover,.button-5:focus,.fusion-button.button-5:active{background: rgba(255, 255, 255, 0.25);}.fusion-button.button-5 .fusion-button-text {text-transform:uppercase;}<\/style><a class=\"fusion-button button-flat button-xlarge button-custom button-5 fusion-button-default-span fusion-animated\" data-animationType=\"fadeInUp\" data-animationDuration=\"1\" data-animationOffset=\"100%\" target=\"_self\" href=\"https:\/\/www.localmed.com\/offices\/408ff5b7-a8e5-4fbe-91e5-d71d7d509a7f\/widget\/?chrome=&amp;hidePartnerLogo=true&amp;partnerId=&amp;referringWidgetId=614f1c51-33c5-47f2-9c0e-c525d12ef9e0&amp;scheduling=in_widget&amp;utm_campaign=button_widget&amp;utm_content=Independence%20Dental%20Group%20-%20google&amp;utm_medium=widget&amp;utm_source=www.google.com&amp;patientStatusId=&amp;reasonForVisitId=&amp;after=2024-03-06&amp;minDate=2024-03-06\"><span class=\"fusion-button-text\">Book An Appointment NOW<\/span><\/a><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"_links":{"self":[{"href":"https:\/\/idgpa.com\/wp-json\/wp\/v2\/pages\/2595"}],"collection":[{"href":"https:\/\/idgpa.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/idgpa.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/idgpa.com\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/idgpa.com\/wp-json\/wp\/v2\/comments?post=2595"}],"version-history":[{"count":6,"href":"https:\/\/idgpa.com\/wp-json\/wp\/v2\/pages\/2595\/revisions"}],"predecessor-version":[{"id":3006,"href":"https:\/\/idgpa.com\/wp-json\/wp\/v2\/pages\/2595\/revisions\/3006"}],"wp:attachment":[{"href":"https:\/\/idgpa.com\/wp-json\/wp\/v2\/media?parent=2595"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}