First Oral Surgery Consultation | Clarksville TN

Registration Paperwork

There are many different forms you have been asked to read and/or complete. We understand that this may be more paperwork than you may be used to filling out for an appointment. Please understand that all the documents and questionnaires are used to protect your privacy and assist in delivering safe, quality healthcare. As you complete your paperwork, please remember to disclose all medical and surgical history. It is very important that we have an accurate picture of your overall health. Nothing should be minimized or considered trivial.

New Patient Packet Paperwork

Please download the following documents, print out, and fill in with your information. Bring the completed paperwork to your appointment.  If you would prefer, you can also email your completed paperwork to [email protected]  

IMPORTANT: Minors will ONLY be seen in our office when accompanied by a parent or legal guardian. If you are a step-parent or any other person accompanying the patient and you DO NOT have court-issued paperwork indicating that you can consent and make medical decisions for the minor patient, you will be asked to reschedule.

What to Expect at Your Initial Appointment

At Cumberland Surgical Arts, our goal is to educate our patients on their options and assist them in making a well-informed decision. The consultation appointment is scheduled for 20 minutes to 60 minutes depending on the surgical services consulting for. We strive to remain on time and see you promptly. However, emergencies do occur as well as some patients require more time from our doctors due to complex medical conditions. Your patients is appreciated. Please know that you will receive our full attention as well.

Please assist us by providing the following information at the time of your consultation:

  • Your surgical referral slip and any X-rays if applicable (x-rays must be current within 12 months)
  • A list of medications you are presently taking
  • Photo ID. We will not file insurance or accept credit/debit cards without a government-issued photo ID.
  • If you have medical or dental insurance, bring the cards. Please call us at least a week prior to the appointment with this information so we can be prepared with your benefits analysis for your consultation.

Your initial appointment will consist of a consultation including a full exam and review of pertinent diagnostic studies (x-rays, CT scans, etc) will be performed. Dr. Lee and Dr. DeFelice are well versed in the latest techniques in oral, facial, and cosmetic surgery. They will discuss your concerns, goals and expectations before recommending a treatment plan. After identifying the treatment plan, they will then discuss the procedures in detail, along with the recovery period of each procedure.

Following your meeting with the doctor you will have the opportunity to meet with with our Treatment Coordinator. She will provide you with a Complimentary Benefits Analysis, based on information your insurance company has provided to us. She will calculate your deposit due for surgery and explain all payment options, such as financing with you at that time. Please see our Financial Arrangements page for further explanation. Surgery will be scheduled AFTER your consultation appointment during your meeting with our Treatment Coordinator. Unfortunately, surgery cannot be performed on the day of your consultation.

  • Please understand that insurance companies vary in regards to coverage for exams. These arbitrary limits are imposed to contained costs to the insurance company and do not mean that you do not need an exam. Our doctors must conduct a thorough exam and review of your medical history before proceeding with diagnosis and treatment.
  • Please alert the office if you have a medical condition that may be of concern prior to surgery (i.e. diabetes, high blood pressure, heart murmurs, artificial heart valves and joints, rheumatic fever, etc.) or if you are currently taking any medication or vitamin and herbal supplements (i.e., heart medications, insulin, aspirin, blood-thinners (Coumadin or Plavix), Gingko Biloba, Vitamin E, etc.) If you are diabetic, please bring your own glucose monitor.

X-Rays

If your physician or dentist has taken x-rays, you may request that they forward them to our office. If there is not enough time, please pick them up and bring them to our office. If additional films are necessary, they can be taken at our facility. We require a current panoramic x-ray for surgery. We will accept a panoramic x-ray that is no older than 12 months from your appointment date. If you are unable to provide a current panoramic x-ray we are happy to take it for you.

  • Please understand that insurance companies vary in regards to coverage for x-rays. Just because it is not covered does not mean that you do not need it. Those coverage limits are arbitrarily determined by the insurance company and are solely created to reduce costs to the insurance company. We cannot proceed with surgery without current x-rays.

Cosmetic Surgery Consultations

A pre-operative appointment is mandatory for patients undergoing IV or general anesthesia for cosmetic surgery. We will inform you if this will be necessary for your scheduled procedure. This appointment is scheduled for 2 weeks prior to the surgical procedure. At this appointment, the treatment plan will be verified, consents will be reviewed and completed, prescriptions given, pre-operative photos taken, post-operative instructions explained, fees collected, lab work reviewed and patient questions will be answered completely.