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New Patient Info

New Patient Form (Click here for PDF)
All new patients are asked to complete our new patient form prior to their first appointment. Please download our form and bring it with you to the office for your first appointment.

Financial Agreement Form (Click here for PDF)

Notice of Privacy Practices (Click here for PDF)

Privacy Practices Form
This form, Notice of Privacy Practices, presents the information that federal law requires us to give our patients regarding our privacy practices.

Your dental plan is a form of compensation provided by your employer. You can expect the carrier (insurance company) to reimburse you for a portion of our fee. That portion is determined by the contract between your employer and the insurance company. The higher the premium paid by your company, the more generous the reimbursement.

Although we are not a party to the contractual arrangement with your insurance company, we do want to help you receive the maximum reimbursement to which you are entitled. As a convenience to you we will help you process your insurance claims in order for you to receive this maximum benefit. We will also gladly provide dental x-rays and a written diagnostic report should your insurance company have any questions about the services provided.

At all times, you can be confident that we will always provide you with our best services without regard to the limitations imposed by your insurance coverage. To do otherwise would violate our contract with you — a contract we feel morally obligated to honor.

Cancellation Policy:
We reserve the right to charge for appointments cancelled or broken without 24 hours advance notice.

For any questions related to your first visit to the Metropolitan Dental Centre, please call us at 703.503.5031 or email us, and our staff will happy to assist you.

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Dr. Kelliher is a leading Fairfax Virginia cosmetic, restorative and implant dentist, serving residents throughout Northern Virginia, including Fairfax County, Fairfax Station, Washington DC, Annandale, Vienna and Maryland. Our top Fairfax VA cosmetic dental office can enhance your white smile through cosmetic, laser and implant dentistry. Our Fairfax dental office can enhance your existing smile with cosmetic dentistry treatments, which include professional ZOOM teeth whitening, dental porcelain veneers and smile makeovers. As a top cosmetic dentist, our Northern Virginia dental practice treats patients as family with warm caring dental treatments. Find Us on Google+ | Dr. Kelliher on Google+

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