Patient Information

New Patient Forms

Save time by printing and completing your forms before you come to the office. Download each form, print it, and bring your completed forms with you to your first appointment.

• Health History Form
• Privacy Policy
• HIPAA Acknowledgement Form

Payment Policy

The fee schedule in our office has been established after long consideration to what is just and fair. This takes into account the doctor’s experience and expertise as a highly trained specialist, the difficulty of the procedure and the customary fee in our area. Fees for root canal treatment generally range from $1000 to $1,500 and are determined by the location of the tooth in the mouth, the number of canals in the tooth and the overall difficulty of the case.

Insurance

We accept assignment of most insurance programs, provided your co-pay and deductible are paid at the time of service. Your insurance company does not wish to dictate doctor’s fees. They merely pay your claim within the provisions of the benefits defined in your policy. Insurance companies may have different levels of coverage, with those policies having higher premiums covering a greater percentage of the patient’s costs. Your level of protection is a matter between you and your insurance company.

Because of the short term nature of our treatment, payment is expected at the time of service. Should you have questions, please feel free to ask our staff. They would be happy to assist you in any way.

Privacy Policy

Dr. Copeland and staff will protect your privacy. The office adheres to HIPAA Regulations for patient information. Download our Privacy Policy in PDF format.

Patient Instructions

Available for your convenience in PDF format for immediate download.

• Pre-Endodontic Treatment
• Post- Endodontic Treatment

Root Canal Libertyville | Root Canal Gurnee | Root Canal Lake Geneva