New Patient Forms

For your convenience, you can download our new patient forms here, print them out, and bring the completed forms to our office to expedite the paperwork at your first visit. Adobe Acrobat Reader is needed to download these forms.

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Payment Options

We also accept checks, debit cards, and Visa and MasterCard credit cards, as well as payment from Health Savings Accounts and Flexible Spending Plans.

We are passionate about dental care, and don’t want financial barriers preventing you and your family from receiving the quality treatment you deserve.


We’ve made paying for your dental care convenient.

Financing Through CareCredit®

CareCredit is a financing program that offers affordable monthly payment plans spread out over 12, 18, or 36 month terms with low financing rates. With CareCredit, you can finance 100% of your dental care with no up-front costs, no pre-payment penalties, and no annual fees. This is a fantastic option for our uninsured patients. Learn more and apply today at CareCredit.com.

 

Dental Savings with IllumitracSM

Don’t skip out on quality dental care just because you are uninsured or underinsured. Mint Leaf Dental offers an in-house substitute for dental insurance: IllumitracSM. This program provides both adults and children with all the benefits of traditional dental insurance without any of the limitations. Illumitrac allows many patients to partner with Dr. Parikh to achieve maximum oral health.

Click here for more information and to sign-up you and your family up today: www.mint-leaf-dental.illumitrac.com

We offer three ways to save: the Adult HealthyCare and Child HealthyCare Memberships, as well as the Adult PerioCare Membership. Keep your family’s teeth healthy for less than the price of a cup of coffee a day!

Adult Membership
13 and older

$31/mo.
$95 Lifetime Activation Fee

  • Professional dental cleanings (2 per year)
  • Doctor exams (1-2 per year)
  • Needed x-rays*
  • One emergency exam per year (if needed)
  • 15% off all other treatments (some exclusions may apply)
  • $95 Lifetime Activation Free includes first month

For patients with regular cleanings and absence of periodontal disease.

Save $185 per year!

Perio Membership
Periodontal Disease

$48/mo.
$95 Lifetime Activation Fee

  • Perio maintenance cleanings (3 to 4 per year)
  • Doctor exams (1-2 per year)
  • Needed x-rays*
  • One emergency exam per year (if needed)
  • 15% off all other treatments (some exclusions may apply)
  • $95 Lifetime Activation Free includes first month

For patients enrolled in active periodontal maintenance due to prior treatment of periodontal (gum) disease.

Save $217 per year!

Child Membership
12 and younger

$25/mo.
$95 Lifetime Activation Fee

  • Professional dental cleanings (2 per year)
  • Doctor exams (1-2 per year)
  • Needed x-rays*
  • One emergency exam per year (if needed)
  • Fluoride treatment
  • 15% off all other treatments (some exclusions may apply)
  • $95 Lifetime Activation Free includes first month
Save $167 per year!

*As determined by your dentist.

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Dental Insurance

You value your dental insurance, and so do we. That’s why we accept most dental insurance plans! Our highly trained staff is happy to process all of the paperwork for you so that you don’t have to worry about filing or tracking claims.

On the day of your visit, we will collect two payments from you:

1. Your deductible payment (as determined by your insurance plan)

2. An estimated “patient’s responsibility” payment for service(s) performed (as estimated in advance by your insurance plan)

Keep in mind however, that only after your insurance company has actually processed your claim can final payment amounts be determined.

We want you to be able to maximize the benefit of your dental insurance. Please call us – we are happy to provide you with a good faith estimate of coverage.

Find Out More About Dental Insurance

 

No Insurance?

If you don’t have dental insurance, you’re hardly alone. An estimated 100 million Americans – nearly one-third of the population – do not have dental coverage!

Quality dental care is still within your reach. Don’t put off receiving the care you need today because of a lack of dental insurance! We offer flexible payment and financing options, and will work with you on a payment plan that makes sense. Waiting until you are in intense pain to seek treatment will only cost you more money and anguish in the long run.

 

Scheduling

You don’t have all the time in the world. At Mint Leaf Dental, we don’t pretend you do. We work hard to start your appointment on time. On occasion, we need to deviate from our schedule to accommodate dental emergencies, but even then we do what we can to get back on schedule promptly! We strive to schedule appointments that are convenient for you. We don't overbook, because we think you deserve exclusive time with Dr. Parikh.

Please arrive to your appointments on time. Of course, we understand that things sometimes come up. If you will be delayed or unavailable for an appointment, please let us know two business days in advance, or as early as possible. This will help us ensure that we respect all of our patients’ time, and will allow us to reschedule your appointment if necessary.

We look forward to getting to know you!

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8544 S. Hulen St.
Fort Worth, TX 76123