Save some time before your first appointment at LiveHealthy Dental by printing and filling out our new patient forms beforehand!
You have the option to go to any office below. Please let us know what office you would prefer.
If you have any additional questions prior to your appointment, please do not hesitate to call us. We look forward to serving you.
Consent to receive dental treatment: I hereby consent and authorize the doctors and staff members to examine, clean and provide dental treatment to my child. I further consent and authorize the taking of dental x-rays, as they may be considered necessary to diagnose and/or treat my child.
Minor Drop-Off Consent: In the event I drop off my minor child to receive dental services, I hereby consent the doctors and staff, to clean and provide dental treatment to my child. I have listed a contact person to be reached in case of emergency below:
I acknowledge that payment is due at the time of treatment, unless other arrangements are made. I acknowledge that all financially responsible parties are to be present for all treatment planning and financial estimates. I agree that parents/guardians are responsible for all fees and services rendered for treatment of a minor/child. I accept full financial responsibility for all charges not covered by insurance. In the event my account balance remains unpaid in excess of 90 days, I understand that my account will be turned over to a collections agency. I accept full responsibility for all administrative costs and legal fees associated with the collections process. I agree to
reimburse the fees of any collection agency, which may be based on a percentage at a maximum of 54% of the debt, and all costs and expenses, including reasonable attorney’s fees that the dental office incurs in such collection efforts.
I understand that there is a broken appointment policy and I may be charged $40, unless I notify the office within 2 business days of my cancellation.
For your convenience our office takes personal checks. However, I understand a $50 fee will be applied to my account for a bounced check (NSF) and from that point forward, personal checks will no longer be acceptable form of payment.
I, the undersigned, have insurance with and I authorize my insurance company to assign benefits directly to my dental provider, if any, otherwise payable to me for services rendered. I understand that I am financially responsible for all charges whether or not paid by insurance within 30 days from the date of service. I hereby authorize the doctor to release all information necessary to secure the payment of benefits. I authorize the use of this signature on all my insurance submissions whether manual or electronic.
By signing below, I hereto irrevocably waive any and all right to trial by jury in any legal proceeding arising out of or related to this agreement or any treatment services provided by offices affiliated with Narducci Dental Group, P.A., its associates, shareholders, and employees. The scope of this waiver is intended to be all-encompassing of any and all disputes that may be filed in any court and that relate to the subject matter of this agreement.
By signing below, I accept the above terms set forth by the dental office and acknowledge full understanding of said terms.
You the patient have the right to accept or reject dental treatment recommended by your dentist. Prior to consenting to treatment, you should carefully consider the anticipated benefits and commonly known risks of the recommended procedure, alternative treatments, or the option of no treatment. By consenting to treatment, you are acknowledging your willingness to accept known risks and complications, no matter how slight the probability of occurrence.
It is very important that you follow your dentist’s advice and recommendations regarding medication, pre and post treatment instruction, referrals to other dentists or specialist, and return for scheduled appointments. If you fail to follow the advice of your dentist, you may increase the chances of a poor outcome. The patient is an important part of the treatment team. In addition to complying with the instructions given to you by this office, it is important to report any problems or complications you experience so they can be addressed by your dentist.
Certain heart conditions may create a risk of serious or fatal complications. If you (or a minor patient) have a heart condition, advise your dentist immediately so your physician can be consulted if necessary.
If you are a woman on oral birth control medication you must consider the fact that antibiotics might make oral birth control less effective. Please consult with your physician before relying on oral birth control medication if your dentist prescribes, or if you are taking antibiotics.
As with all surgery, there are commonly known risks and potential complications associated with dental treatment. No one can guarantee the success of the recommended treatment, or that you will not experience a complication or less than optimal result. Even though many of these complications are rare, they can and do occur occasionally.
Some of the more commonly known risks and complications of treatment include, but are not limited to the following:
This form is intended to provide you with an overview of potential risks and complications. Please discuss the potential benefits, risks, and complications of recommended treatment with your dentist. Be certain all of your concerns have been addressed to your satisfaction by your dentist before commencing treatment.
I understand that the novel Coronavirus (COVID-19) has been declared a global pandemic by the World Health Organization (WHO). I further understand that COVID-19 is extremely contagious and may be contracted from various sources. I understand COVID-19 has a long incubation period during which carriers of the virus may not show symptoms and still be contagious. I understand that I am the decision maker for my health care. Part of this office’s role is to provide me with information to assist me in making informed choices. This process is often referred to as “informed consent” and involves my understanding and agreement regarding recommended care, and the benefits and risks associated with the provision of health care during a pandemic. Given the current limitations of COVID-19 virus testing, I understand determining who is infected with COVID-19 is exceptionally difficult.
1) I understand my treatment may create circumstances, such as the discharge of respiratory droplets or person-to-person contact, in which COVID-19 can be transmitted.
2) I understand due to the frequency of appointments with patients, the attributes of the virus, and the characteristics of procedures, I may have an elevated risk of contracting COVID-19 simply by being in a health care office.
3) I confirm I am not experiencing any of the following symptoms of COVID-19 that are listed below: *Fever *Shortness of Breath *Dry Cough *Runny Nose *Sore Throat *Loss of Taste or Smell
4) I am informed that you and your staff have implemented preventative measures intended to reduce the spread of COVID-19. However, given the nature of the virus, I understand there may be an inherent risk of becoming infected with COVID-19 by proceeding with this treatment. I hereby acknowledge and assume the risk of becoming infected with COVID-19 through this elective treatment and give my express permission to you and the staff at your offices to proceed with providing care.
I KNOWINGLY AND WILLINGLY CONSENT TO THE TREATMENT WITH THE FULL UNDERSTANDING AND DISCLOSURE OF
THE RISKS ASSOCIATED WITH RECEIVING CARE DURING THE COVID-19 PANDEMIC. I CONFIRM ALL OF MY QUESTIONS
WERE ANSWERED TO MY SATISFACTION. I HAVE READ, OR HAVE HAD READ TO ME, THE ABOVE COVID-19 RISK
INFORMED CONSENT TO TREAT. I APPRECIATE THAT IT IS NOT POSSIBLE TO CONSIDER EVERY POSSIBLE COMPLICATION TO CARE.
I HAVE ALSO HAD AN OPPORTUNITY TO ASK QUESTIONS ABOUT ITS CONTENT, AND BY SIGNING BELOW, I AGREE WITH THE CURRENT OR FUTURE RECOMMENDATION TO RECEIVE CARE AS IS DEEMED APPROPRIATE FOR MY CIRCUMSTANCE. I INTEND THIS CONSENT TO COVER THE ENTIRE COURSE OF CARE FROM ALL PROVIDERS IN THIS OFFICE FOR MY PRESENT CONDITION AND FOR ANY FUTURE CONDITION(S) FOR WHICH I SEEK CARE FROM THIS OFFICE.
I, , hereby acknowledge that I have received and reviewed a copy of Narducci Dental Group, P.A., and affiliated dental practices HIPAA Notice of Privacy Practices.
I understand that Narducci Dental Group, P.A., and affiliated dental practices HIPAA Notice of
Privacy Practices may change periodically and that I am entitled to receive a copy of Narducci
Dental Group, P.A., and affiliated dental practices revised HIPAA Notice of Privacy Practices
I understand that, if I have questions about Narducci Dental Group, P.A., and affiliated dental
practices HIPAA Notice of Privacy Practices, I may contact Narducci Dental Group, P.A., at (904)
I understand that it is my right to refuse to sign this Acknowledgement should I so choose, and
that Narducci Dental Group, P.A. and affiliated dental practices will not refuse treatment to me if I
refuse to sign this Acknowledgement.
I further understand that I may contact the Secretary of the U.S. Department of Health and
Human Services should I have concerns regarding Narducci Dental Group, P.A. and affiliated
dental practices privacy policies and procedures. For information on how to contact the U.S.
Department of Health and Human Services, please ask Narducci Dental Group, P.A., at (904)
998-7000, noted above, for assistance.
Bisphosphonates are a type of drug given to millions of Americans to treat osteoporosis or as part of cancer treatment, namely for breast cancer, lung cancer, prostate cancer, multiple myloma, Paget’s disease of the bone, alveolar necrosis of the bone or postmenopausal osteoporosis. They are sometimes given orally and other times are given through people’s veins. Some of the common names include but are not limited to:
In rare instances, some people on these drugs have developed a condition called Osteonecrosis of the jaw, which results in severe damage to or loss of the jaw bone. Symptoms include but are not limited to pain, swelling or infection of the gums or jaw, gums that are not healing, loose teeth, numbness or a heavy feeling in the jaw, drainage and exposed bone. There is no proven treatment to fix this problem.
Accordingly, patients on these drugs should know the risks, benefits, and alternatives of invasive dental procedures. If a patient is on Bisphosphonates, your dentists, follows special procedures to promote the safety of the patient. It is very important that you let the dentist know whether you are taking any medications, particularly a Bisphosphonates drug, or if you have ever taken a Bisphosphonate drug. If you are not sure if the drugs you are taking are Bisphosphonates, ask the dentist. You have a duty and responsibility to tell the dentist all the drugs that you take.
I hereby disclose that:
YES, I AM on a Bisphosphonate or have taken one in the past. It is called: I have taken this medication for: (Amount of time) NO, I am NOT on any Bisphosphonates and have never taken or been given Bisphosphonates.
I UNDERSTAND THAT THE COMPLICATION STATED ABOVE CAN HAPPEN WITH SURGICAL AND NON-SURGICAL
TREATMENT, AS WELL AS, SPONTANEOUSLY AND AGREE TO PROCEED WITH THE RECOMMENDED TREATMENT:
We have the ability to send text and email messages to your provided cell phone number to receive account information such as appointment reminders, appointment openings, account updates, marketing specials, opportunities, and other alerts
Please indicate below whether you would like to receive text and email confirmation,reminders,newsletters,specials, and other updates. Text message charges from your cell phone provider may apply.
By signing below, I wish to enroll in the text message and email alert communication explained above
You can withdraw your consent at any time by calling the office. You are resposible providing updates to your cell phone and email information
It is important to note that text communication is not always secure. Text messages can be intercepted and for this reason, we do not communicate personal health information through this method.
Darla is an Account Specialist. She is originally from Missouri. Darla has two adult children that she is extremely proud of!
Darla loves her position because she enjoys troubleshooting, problem solving, and working independently. Outside of the office, Darla loves to garden and read. She also loves animals and has a 14 year old dog.
Nancy is from a large family, and she is the sixth out of seven kids.
Her parents are originally from Haiti. Nancy graduated from Darnell Cookman High School and is currently attending FSCJ. She loves the dental field because it allows her to give back to the community. In her free time, she enjoys writing and playing the piano.
Amber is a Senior Account Specialist and has been with our team for 7 years.
She enjoys working in the dental field because she is amazed how the dental treatment can help a persons’ overall health. She is the Sunday School director at her church and she enjoys trips to SeaWorld in her free time.
Georganna has been practicing as a dental hygienist for almost seven years. She has several years of experience in a large group practice as a dental hygienist and hygiene mentor.
Georganna has a younger brother and sister. She has a full house with four dogs and two cats. Georganna grew up and lives in Dunnellon, Florida, and she studied at Santa Fe College in Gainesville, Florida. Her hobbies include fishing, mudding, going to the beach, and any activity that involves water, sun, friends, and family. She also enjoys volunteering her time with local youth as a pop warner cheerleading coach. Georganna loves to learn new things and help others.and your users are sure to see it!
Ashley serves as a hygiene mentor for Narducci Dental Group. She is a true advocate for her patients
In her spare time, Ashley enjoys spending time outdoors. She likes traveling on summer vacations to the Keys and Connecticut, and to her family home in the mountains.
( LiveHealthy Dental )
Majorie began her career in dentistry in 2001. Majorie has worked with Dr. Narducci since 2001 as a Dental Assistant
She also brings a wealth of 18 years of dental experience to our team. Majorie has worked in both the large dental service organization setting, as well as the private practice setting.
Throughout her career, she was mentored by Dr. Narducci, to be the lead assistant in comprehensive dental cases, from the initial treatment planning phase, to assisting in the administration of dental treatment, to post-operative service and care.
At NDG, Majorie plays a critical role in leading her dental assisting teams at maximizing their skill sets, to allow the doctors to concentrate on their craft. These skills include dental assisting, building patient relationships, leading treatment teams, schedule management, and patient education and prioritizing. Majorie is also responsible for selecting, hiring, and training new dental assistants in the practice group. She also mentors novice assistants beginning their career and provides them with the foundational knowledge needed to assist in implementing a high standard of care, as well as ensuring that schedules are maximizing productivity.
As the dental assistants are progressing, Majorie responds to each practice to train and groom dental assistants as they progress in their level of patient care. Majorie is committed in helping her patients, as well as her team members grow and improve.
Not only is Majorie a critical leader at NDG, she is also an exceptional leader in her community. Majorie has served as a cultural liaison in NDG’s mission trips to Haiti. Her passion is also centered in youth growth and empowerment, and she leads the Adventurer’s Club, a youth group at her local church. She is also Health Department Leader, a member of the choir, and a Ministry Leader in her local church.
Majorie is married to John Jerome, and they have four energetic boys. She enjoys spending time with her family, and loves to cook, sing, dance, and supports her cultural community as a mentor.
Kristina is an Executive Assistant to the Narducci Dental Leadership Team. Kristina comes with a diverse background of experiences prior to Narducci Dental Group. She has an educational background in healthcare and has worked in hospital settings with direct patient care. Kristina also worked for several years in the hospitality industry with a luxury hotel property, providing world class service to guests from all over the world.
In her spare time, Kristina has a passion to make a difference to those in need and often organizes donation packages for her local community and church. Her hobbies include reading, running, working out, cooking, spending time with her family, singing, dancing, and exploring new places and activities. Kristina loves to take on new projects, continually learn and grow, and help others achieve their goals.
Elizabeth Bilbrey is the Regional Manager of the central Florida locations
She has been married to husband Terry for 24 years and have three adult children, Georganna, Shane, and Marissa. She also has two granddaughters, aged 5 (Bristol) and 6 (Madelyn).
Elizabeth Bilbrey is the Regional Manager of the central Florida locations. She has been married to husband Terry for 24 years and have three adult children, Georganna, Shane, and Marissa. She also has two granddaughters, aged 5 (Bristol) and 6 (Madelyn). Elizabeth relocated from Indiana to Florida in April 2003 with her family.
Elizbeth has 6 years of experience in dental practice administration in a corporate practice setting. She started out as a business assistant and worked her way up to multiple positions and managed multiple offices, and eventually became a Practice Manager of Operations.
Prior to her dental career, she owned and operated two mortgage broker establishments for almost 20 years. The first was in Indiana, and she opened a second company when she relocated to Florida.
In her spare time, Elizabeth loves to serve her community in helping her daughters coach a pop warner cheerleading program, specifically the 8- 10 year old division. She also enjoys spending time on her dock with her husband while enjoys fishing. Elizabeth likes to read or listen to anything that is inspirational and related to self-growth or leadership.
Elizabeth finds that she can impact NDG patients the most through growing and inspiring the teams and any individuals that surround her. She enjoys her work in dentistry because this process is so rewarding. By helping others be the best that they can possibly be, both personally and clinically, her teams are able to deliver the “WOW” experience to each and every patient in multiple offices.
Robin began her career as a marine biologist, studying estuarine fish populations for over a decade.
She never dreamed of joining the field of dentistry, but through it has now found her true passion – turning numbers into meaningful tools and ensuring the best financial experience possible for patients and dental teams.
Robin began her career as a marine biologist, studying estuarine fish populations for over a decade. She never dreamed of joining the field of dentistry, but through it has now found her true passion – turning numbers into meaningful tools and ensuring the best financial experience possible for patients and dental teams.
Robin comes to NDG with a wealth of experience working with teams in a multiple practice settings optimize their operations from a financial and efficiency perspective. She has worked in many roles in dental business operations, including on-site business administration and off-site operational support. Robin has a talent of leading behind the scenes teams in the most productive and efficient manner possible, thus bringing a tremendous amount of value to the NDG leadership team.
Outside of the office, Robin enjoys rural life. She grew up in a small town and spent her time between the roller rink and horse barn. Learning new roller dances with her mom is a memory that will always make her smile, and though she does not go as often as she would like now, she never passes up the chance to lace up her skates. Robin also runs obstacle races, kayaks, and spends as much time in nature as possible. Her favorite time of year is winter, and she deeply misses building snowmen. What Robin loves most about dentistry is having the opportunity to work inside the business so the front office teams can focus on what they do best – building relationships with our patients.
Annette brings a wealth of experience of over 25 years in the dental field, as she began as a Dental Assistant.
She has filled many roles within dentistry, from a Dental Assistant, to a Practice Administrator, to an Operations Manager serving many practices at once.
Annette was born and raised in Michigan. Shas been married to her husband Kevin for over 30 years. They have two adult children, AJ and Kate. In her spare time, she loves spending time at the beach and reading.
Annette not only loves dentistry, but is truly passionate about coaching her teams to their fullest potential. She loves seeing people evolve and grow within their profession, which in turn gives patients the best dental care that they deserve.
Valerie is a Regional Administrator of the Specialty Department. She has been a resident of Florida since the 1970s after traveling all over the US and Europe as a child. She previously attended ECC in Fort Myers and the University of Florida. She majored in Management in college, and shortly after she realized that she was not the type to sit isolated without interactions from others. As a result, Valerie applied for an entry level dental assistant. She fell in love with dentistry and was amazed at how diseased teeth affected the overall health of an individual, and discovered the positive impact she could have through dentistry.
Valerie also found that assisting a doctor during surgical procedures had taken her excitement and curiosity to a whole new level. She found her niche’ and her passion has only grown from that moment. Valerie loves being in dentistry because she can make a difference in people’s lives through education and compassion. It has been her mission for decades, and it is still her mission today.
Outside of work, Valerie’s life is family centered with husband Rick and daughters, Paige and Heather. They are all UF Florida Gators!!!! She also loves crafting with her cricut cutter, decorating cakes, interior decorating, gardening, boating, jetskiing, and playing golf.
Lisa is the Practice Administrator of Marietta Dental. She has over 30yrs experience in the dental field. Dental health has been a lifelong
commitment to Lisa. In her spare time, Lisa also works retail where she has dedicated 18yrs of services too as well. She also enjoys traveling, wine tastings, and visiting her family in Virginia.
Celise: is a Hygiene Assistant at Marietta Dental. Celise posses 2yrs of experience in the dental field. Prior to working at Marietta Dental Celise
was a patient care specialist at a periodontal office in the Jacksonville area. In Celise’s free time she enjoys spending time with her family and building and refurbishing old trucks.
Kyra started with Marietta Dental fresh out of school. After working a few months Kyra decided she wanted to expand her knowledge in the dental field and started working with our Specialty Team. Kyra has been with Live Healthy Dental for 3yrs now and is currently back working at Marietta Dental. She enjoys going to the beach and eating at Tokyo Ramen. Sushi is this girl’s life.
Natalie started with Live Healthy Dental as an account specialist at our support office, however, after some time she realized she loved meeting and interacting with patients, so she decided to transfer to the frontline. She has now been the Business Assistant at Marietta Dental for almost 2 years. Natalie has a passion for event planning and interior design, she likes to make sure our Marietta Office is always decorated for the current season and holiday. In her spare time, you will find her spending time with her family and her fur babies. Her hobbies include decorating, organizing, camping, kayaking, and boating. Natalie absolutely adores her job and the team she works with; her favorite part of her job is getting to know her team and the patients more.
Courtney has been a dental assistant for nearly a year now with Marietta Dental. She has a passion for helping and educating patients. Courtney is also a graduate from FSU with a degree in Criminology. In her spare time she enjoys spending time with her friends and family and if the weather is right a quick trip down to our beaches sitting in the sand enjoying the fresh air.
Rachel grew up in Jacksonville, Fl and attended school at Florida State College of Jacksonville, completing her degree in Dental Hygiene. She is married with two children and lots of farm animals. Rachel enjoys being outdoors and traveling. Rachel has been a Dental Hygienist at Marietta Dental for just over a year and is very grateful to work at one of the best dental offices in Jacksonville! She loves her career as a Dental Hygienist and really enjoys giving her patients a beautiful, healthy smile.
James Suarez, RDH with qualification to administer local anesthesia; BLS provider - fluent in English and Tagalog.Dental hygienist since June 2017 Doctor of Dental Medicine - University of the East - 05/2008; practiced dentistry in NCR, the Philippines for 6 months before coming back to Jacksonville, Florida.BS Biology from Univ. of Central Florida - 08/2003. My Hobbies include collecting comics since 1990, going to punk rock concerts since high school - also listening to hip hop, Jamaican music, heavy metal; going to the movies eating popcorn, and drinking Icees’. I’m currently going to title boxing gym, skateboarding, and drawing. I believe the Jacksonville Jaguars could be doing a lot better but enjoy going to games every chance I get to root for them.
Expanded Functions Dental Assistant since 2011. Michelle has a diverse background before joining Live Healthy Dental. I’ve worked in a customer service/call center as well as a daycare prior to going to Kaplan to earn a diploma as E.F.D.A.I enjoy being around family and have an interest in old black and white suspense films (mostly Alfred Hitchcock) and I love scary movies. My hobbies include shopping, reading, and cooking.