Patient Information

The staff at Douglas A. Pulsipher, DDS, Ahwatukee Foothills Dental Care is committed to providing excellent dental care in a comfortable environment where patients can relax and feel at ease. Here you will find information on what to expect during your first appointment along with links to patient forms and paperwork.

Contact Us
We are happy to hear from you, answer your questions, and schedule an appointment. Call Douglas A. Pulsipher, DDS, Ahwatukee Foothills Dental Care at 480-482-4789 or stop by our office.

4350 E Ray Rd, #116
Phoenix, AZ 85044

New Patients

It is easy to make an appointment for your initial examination and dental treatments. Call 480-482-4789 to speak with a staff member and you can download the New Patient Form by clicking the link.

Downloadable Forms:

New Patient Forms

Our Financial Policy

Thank you for choosing us as your dental health care provider. We are committed to providing quality dental care. In order to reduce potential confusion and misunderstandings, we have adopted the following Financial Policy that you will need to read and sign prior to commencement of any treatment.

As dental healthcare providers, our relationship is with you and not your insurance company. While the filing of insurance claims is a courtesy that we extend to our patients all charges are your responsibility from the date the services are rendered.

Your insurance policy is a contract between you and your insurance company. For us to bill your insurance company you must provide us current and valid insurance information. As a courtesy, we will file your insurance claim for you if you assign the benefits to this office. Co-payments, deductibles and any amount estimated that insurance will not cover must be paid at the time services are rendered. Forms of payment include cash, checks, most major credit cards, and third party financing is available on approved credit. If your insurance company does not pay within 60 days you will be responsible to pay any unpaid balance at that time.

We are generally very helpful and accurate in estimating what your insurance will cover. However, dental insurance coverage does vary greatly. Occasionally they do not cover what is expected. We are not responsible for and have no control over your insurance company’s coverage or decisions. In the event the insurance company does not cover a service, you will be responsible for the complete amount. We encourage all patients to contact their insurance carrier and become familiar with their own plans, coverage and any exclusions.

Ultimately it is the insured patient’s responsibility to dispute any problems with their insurance company regarding discrepancies with coverage. As a courtesy we may send a letter and/or make a phone call on your behalf.

It is your responsibility to notify our office when your insurance plan or benefits change. You must also advise us when you use your dental benefits at other offices or our benefit estimates may be incorrect. Any costs resulting from incorrect or incomplete insurance information provided or omitted by you is clearly your responsibility.

A parent or legal guardian must accompany a minor patient on his or her first visit to our office so we can obtain a signature to treat the minor patient. A minor may be treated on subsequent visits without a parent or guardian if we have permission from the parent or legal guardian and payment arrangements are made in advance. The adult accompanying a minor patient is responsible for payment of the services rendered at the time of service.

There is a service fee of $25 for all returned checks and a $50 fee for missed appointments or late cancellations (less than 24 hours).

In addition to these terms, I acknowledge and agree that I am personally responsible for all services rendered to me and / or my dependents.

I further agree that a 1.5% finance charge (18% APR) will be added to any balance over 30 days. In the event that I default, I agree to pay all collection costs necessary to collect the debt, including reasonable attorney fees.


We are in network for the following insurance companies: DELTA DENTAL - Premier, CMDP
We continue to accept most other insurances as long as you can go "out of network".

Payment Methods – Check or Cash Accepted


Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.