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Patient Forms - Olney, MD

You’ll Love How
We Treat You Here

coordinator with vivian before surgery

Welcome To Olney Center for Oral & Maxillofacial Surgery!

The team at Olney Center For Oral and Maxillofacial Surgery is excited to offer you a warm welcome. Our goal is to help you feel relaxed and comfortable during all phases of your treatment at our practice and to offer you the very highest quality of care. During your initial consultation appointment with Dr. Tebyanian, you will receive a full examination and an explanation of your diagnosis, and a treatment plan will develop based on your oral surgery goals and condition. Most oral surgery treatments are performed during a later appointment, but some procedures may be performed the same day as your consultation.

It is likely that diagnostic images will be taken during your first visit. If your general dentist or referring physician has already taken X-rays or scans, please remember to bring them with you to your appointment. You may also request that your dentist or doctor forward the images to our practice for review.

Patient Forms

Patient Forms

To protect your Privacy, and Security of your personal health information (PHI) the office complies with the Federal Health Insurance Portability and Accountability Act. “HIPAA” and prohibits the use of phones and other electronic devices in the clinical areas. The use of phones and other devices are approved in non-clinical areas.

 

Pay Bill Here

Pay Bill Here 

We offer an easy and secure way to pay your bill online. Follow the link below.

Click Here

For The Most Efficient
Evaluation And Treatment Planning

Please be sure to alert us to any prior medical conditions that Dr. Tebyanian should be aware of before surgery, including diabetes, high blood pressure, artificial heart valves and joints, rheumatic fever, and other significant medical conditions. If you are currently taking medications such as heart medications, aspirin, anticoagulant therapy, etc., please let us know. If you have not previously completed the medical/dental health questionnaire, the patient information form, and the financial information form, we ask you to please arrive a few minutes early to allow time to complete these important forms. We ask that you please bring the following to your first appointment:

  • Your health and/or dental insurance information.
  • A list of current medications you are taking, if any.
  • Any referral forms or X-rays given to you by your dentist or physician.
  • A valid driver’s license or photo ID.
  • Your payment information.

It is important to note that a parent or guardian must accompany all patients under the age of 18 for the consultation visit.

Most Efficient Evaluation

For The Most Efficient Evaluation And Treatment Planning

We ask that you please bring the following to your first appointment:

  • Your health and/or dental insurance information
  • A list of current medications you are taking, if any
  • Any referral forms or X-rays given to you by your dentist or physician
  • A valid driver’s license or photo ID
  • Your payment information

It is important to note that a parent or guardian must accompany all patients under the age of 18 for the consultation visit.

Olney center for oral & maxillofacial surgery logo
Please Alert Us Before Surgery

Please Alert Us Before Surgery

Please be sure to alert us to any prior medical conditions that Dr. Tebyanian should be aware of before surgery, including diabetes, high blood pressure, artificial heart valves and joints, rheumatic fever, and other significant medical conditions. If you are currently taking medications such as heart medications, aspirin, anticoagulant therapy, etc., please let us know. If you have not previously completed the medical/dental health questionnaire, the patient information form, and the financial information form, we ask you to please arrive a few minutes early to allow time to complete these important forms.

Thank you for taking the time to review this information. We look forward to providing you with excellent oral surgery care in an inviting and professional setting.

OMS
American Board of Oral and Maxillofacial Surgery
MASOMS
MSOMS
ADA
Adventist Health Care
MedStar Health
Olney chamber of commerce logo
George Mason
UCONN
Stony Brook
Northwell Health