{"id":40,"date":"2017-01-03T09:55:38","date_gmt":"2017-01-03T15:55:38","guid":{"rendered":"https:\/\/www.johnrstriebeldds.com\/?page_id=40"},"modified":"2025-06-30T21:22:54","modified_gmt":"2025-07-01T02:22:54","slug":"patient-information","status":"publish","type":"page","link":"https:\/\/www.johnrstriebeldds.com\/patient-information\/","title":{"rendered":"Patient Information"},"content":{"rendered":"\n<h1>\n\t\tPatient Information\n\t<\/h1>\n\t\t\t\t<img decoding=\"async\" src=\"http:\/\/www.dental.inceptionimages.com\/wp-content\/uploads\/2017\/01\/woman-professional-staff-smiling.jpg\" alt=\"woman-professional-staff-smiling.jpg\" itemprop=\"image\" title=\"woman-professional-staff-smiling.jpg\" onerror=\"this.style.display='none'\"  \/>\n\t<h3>New Patient Paperwork<\/h3>\n<p><a href=\"\/\">John R. Striebel, DDS<\/a> offers our patient form(s) online so they can be completed in the convenience of your own home or office.<\/p>\n<ul>\n<li>All forms are PDF files. You will need AdobeReader\u00ae to view them.<\/li>\n<li>If you do not already have AdobeReader\u00ae installed on your computer,<br \/>\n<a href=\"http:\/\/get.adobe.com\/reader\/\" target=\"_blank\" rel=\"noopener\">Click Here<\/a>\u00a0to download.<\/li>\n<li>Download the necessary form(s), print them out and fill in the required information.<\/li>\n<li>Bring the necessary form(s) to your appointment.<\/li>\n<\/ul>\n\t<ul>\n\t\t<li><a href=\"https:\/\/www.johnrstriebeldds.com\/wp-content\/uploads\/2025\/05\/1.-Patient-Information-Sheet.pdf\" target=\"_blank\" rel=\"noopener nofollow\" aria-label=\"Go to https:\/\/www.johnrstriebeldds.com\/wp-content\/uploads\/2025\/05\/1.-Patient-Information-Sheet.pdf\">\t\t\t\t\n\t\t<p>1. Patient Information SheetClick to Download<\/p><\/a><\/li><li><a href=\"https:\/\/www.johnrstriebeldds.com\/wp-content\/uploads\/2025\/05\/2.-Medical-History-Sheet.pdf\" target=\"_blank\" rel=\"noopener nofollow\" aria-label=\"Go to https:\/\/www.johnrstriebeldds.com\/wp-content\/uploads\/2025\/05\/2.-Medical-History-Sheet.pdf\">\t\t\t\t\n\t\t<p>2. Medical History SheetClick to Download<\/p><\/a><\/li><li><a href=\"https:\/\/www.johnrstriebeldds.com\/wp-content\/uploads\/2025\/05\/3.-Dental-History-Sheet.pdf\" target=\"_blank\" rel=\"noopener nofollow\" aria-label=\"Go to https:\/\/www.johnrstriebeldds.com\/wp-content\/uploads\/2025\/05\/3.-Dental-History-Sheet.pdf\">\t\t\t\t\n\t\t<p>3. Dental History SheetClick to Download<\/p><\/a><\/li>\t<\/ul>\n\t<ul>\n\t\t<li><a href=\"https:\/\/www.johnrstriebeldds.com\/wp-content\/uploads\/2025\/05\/Patient-Yearly-Update.pdf\" target=\"_blank\" rel=\"noopener nofollow\" aria-label=\"Go to https:\/\/www.johnrstriebeldds.com\/wp-content\/uploads\/2025\/05\/Patient-Yearly-Update.pdf\">\t\t\t\t\n\t\t<p>Patient Yearly UpdateClick to Download<\/p><\/a><\/li><li><a href=\"https:\/\/www.johnrstriebeldds.com\/wp-content\/uploads\/2025\/05\/4.-Financial-Policy-Sheet.pdf\" target=\"_blank\" rel=\"noopener nofollow\" aria-label=\"Go to https:\/\/www.johnrstriebeldds.com\/wp-content\/uploads\/2025\/05\/4.-Financial-Policy-Sheet.pdf\">\t\t\t\t\n\t\t<p>4. Financial Policy SheetClick to Download<\/p><\/a><\/li><li><a href=\"https:\/\/www.johnrstriebeldds.com\/wp-content\/uploads\/2025\/05\/5.-HIPAA-Sheet.pdf\" target=\"_blank\" rel=\"noopener nofollow\" aria-label=\"Go to https:\/\/www.johnrstriebeldds.com\/wp-content\/uploads\/2025\/05\/5.-HIPAA-Sheet.pdf\">\t\t\t\t\n\t\t<p>5. HIPAA SheetClick to Download<\/p><\/a><\/li><li><a href=\"https:\/\/www.johnrstriebeldds.com\/wp-content\/uploads\/2025\/05\/6.-Appt.-Sch.-Missed-Appt.-Sheet.pdf\" target=\"_blank\" rel=\"noopener nofollow\" aria-label=\"Go to https:\/\/www.johnrstriebeldds.com\/wp-content\/uploads\/2025\/05\/6.-Appt.-Sch.-Missed-Appt.-Sheet.pdf\">\t\t\t\t\n\t\t<p>6. Appointment Scheduling &#038; Missed Appointment PolicyClick to Download<\/p><\/a><\/li>\t<\/ul>\n\t<hr \/>\n<h3>Financial Policy<\/h3>\n<p>We firmly believe that financial considerations should not be an obstacle to obtaining the treatment you desire. We are sensitive to the fact that each patient has different needs and have several payment options available so that treatment is accessible to everyone. All financial discussions and arrangements are kept strictly confidential.<\/p>\n<hr \/>\n<h3>Insurance Information<\/h3>\n<p>Dental insurance is diverse. Some policies cover only a small percentage of fees, while others cover 50 percent or greater. The more you or your employer pays for premiums, the better the coverage, in most cases. Dental insurance can be confusing, but we&#8217;ll make it easy for you. Simply bring your card or claim into our office. We&#8217;ll be happy to tell you what your insurance will cover and file your claim for you.<\/p>\n\t<div class=\"fl-builder-content fl-builder-content-9634 fl-builder-global-templates-locked\" data-post-id=\"9634\"><div class=\"fl-row fl-row-fixed-width fl-row-bg-none fl-node-5cf01d4ac70ba fl-row-default-height fl-row-align-center\" data-node=\"5cf01d4ac70ba\">\n\t<div class=\"fl-row-content-wrap\">\n\t\t<div class=\"uabb-row-separator uabb-top-row-separator\" >\n<\/div>\n\t\t\t\t\t\t<div class=\"fl-row-content fl-row-fixed-width fl-node-content\">\n\t\t\n<div class=\"fl-col-group fl-node-5cf01d4ac6e52\" data-node=\"5cf01d4ac6e52\">\n\t\t\t<div class=\"fl-col fl-node-5cf01d4ac6f65 fl-col-bg-color\" data-node=\"5cf01d4ac6f65\">\n\t<div class=\"fl-col-content fl-node-content\"><div class=\"fl-module fl-module-photo fl-node-5cf01d4ac6f9e fl-animation fl-bounce-in symptomhover\" data-node=\"5cf01d4ac6f9e\" data-animation-delay=\".2\" data-animation-duration=\"1\">\n\t<div class=\"fl-module-content fl-node-content\">\n\t\t<div class=\"fl-photo fl-photo-align-center\" itemscope itemtype=\"https:\/\/schema.org\/ImageObject\">\n\t<div class=\"fl-photo-content fl-photo-img-webp\">\n\t\t\t\t<a href=\"\/appointments\/\" target=\"_self\" itemprop=\"url\">\n\t\t\t\t<img decoding=\"async\" class=\"fl-photo-img\" src=\"https:\/\/www.johnrstriebeldds.com\/wp-content\/uploads\/2019\/05\/Dentist-Near-Me-Miamisburg-OH-Request-An-Apppointment.webp\" alt=\"Dentist Near Me Miamisburg OH Request An Appointment\" itemprop=\"image\" title=\"Dentist-Near-Me-Miamisburg-OH-Request-An-Apppointment.webp\"  \/>\n\t\t\t\t<\/a>\n\t\t\t\t\t<\/div>\n\t<\/div>\n\t<\/div>\n<\/div>\n<style>.fl-node-5cf01d4ac6f9e.fl-animation:not(.fl-animated){opacity:0}<\/style><\/div>\n<\/div>\n\t<\/div>\n\n<div class=\"fl-col-group fl-node-5cf01d4ac6e89\" data-node=\"5cf01d4ac6e89\">\n\t\t\t<div class=\"fl-col fl-node-5cf01d4ac6fd6 fl-col-bg-color\" data-node=\"5cf01d4ac6fd6\">\n\t<div class=\"fl-col-content fl-node-content\"><div class=\"fl-module fl-module-info-box fl-node-ywkatvdx4m17\" data-node=\"ywkatvdx4m17\">\n\t<div class=\"fl-module-content fl-node-content\">\n\t\t<div class=\"uabb-module-content uabb-infobox infobox-center \">\n\t<div class=\"uabb-infobox-left-right-wrap\">\n\t<div class=\"uabb-infobox-content\">\n\t\t\t<div class='uabb-infobox-title-wrap'><p class=\"uabb-infobox-title\">John R. Striebel, DDS<\/p><\/div>\t\t\t<div class=\"uabb-infobox-text-wrap\">\n\t\t\t\t<div class=\"uabb-infobox-text uabb-text-editor\"><p>9200 Marketplace Dr<br \/>Miamisburg, OH 45342<\/p>\n<\/div><a href=\"tel:9372911822\" target=\"_self\" rel=\"nofollow\" class=\"uabb-infobox-cta-link\">(937) 291-1822<\/a>\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\t<\/div>\n<\/div>\n\t<\/div>\n<\/div>\n<\/div>\n<\/div>\n\t<\/div>\n\n<div class=\"fl-col-group fl-node-5cf01d4ac6ebf\" data-node=\"5cf01d4ac6ebf\">\n\t\t\t<div class=\"fl-col fl-node-5cf01d4ac7049 fl-col-bg-color\" data-node=\"5cf01d4ac7049\">\n\t<div class=\"fl-col-content fl-node-content\"><div class=\"fl-module fl-module-rich-text fl-node-5cf01d4ac7082\" data-node=\"5cf01d4ac7082\">\n\t<div class=\"fl-module-content fl-node-content\">\n\t\t<div class=\"fl-rich-text\">\n\t<hr style=\"height: 1px; margin: 5px 50px 12px 50px; border: none; color: #ccc; background-color: #ccc;\" \/>\n<p style=\"text-align: center;\"><span style=\"color: #2d9ac7; font-size: 20px;\"><strong>OFFICE HOURS<\/strong><\/span><\/p>\n<hr style=\"height: 1px; margin: 5px 50px 5px 50px; border: none; color: #ccc; background-color: #ccc;\" \/>\n<p style=\"text-align: center; line-height: 20px;\"><span style=\"font-size: 15px;\"><strong>Monday<\/strong><\/span><br \/>\n<span style=\"font-size: 15px;\">8:00am - 5:00pm<\/span><\/p>\n<p style=\"text-align: center; line-height: 20px;\"><span style=\"font-size: 15px;\"><strong>Tuesday<\/strong><\/span><br \/>\n<span style=\"font-size: 15px;\">8:00am - 5:00pm<\/span><\/p>\n<p style=\"text-align: center; line-height: 20px;\"><span style=\"font-size: 15px;\"><strong>Wednesday<\/strong><\/span><br \/>\n<span style=\"font-size: 15px;\">8:00am - 5:00pm<\/span><\/p>\n<p style=\"text-align: center; line-height: 20px;\"><span style=\"font-size: 15px;\"><strong>Thursday<\/strong><\/span><br \/>\n<span style=\"font-size: 15px;\">8:00am - 5:00pm<\/span><\/p>\n<p style=\"text-align: center; line-height: 20px;\"><span style=\"font-size: 15px;\"><strong>Friday<\/strong><\/span><br \/>\n<span style=\"font-size: 15px;\">8:00am - 12:00pm<\/span><\/p>\n<p style=\"text-align: center; line-height: 20px;\"><span style=\"font-size: 15px;\"><strong>Saturday &amp; Sunday<\/strong><\/span><br \/>\n<span style=\"font-size: 15px;\">Closed<\/span><\/p>\n<\/div>\n\t<\/div>\n<\/div>\n<\/div>\n<\/div>\n\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<\/div><div class=\"uabb-js-breakpoint\" style=\"display: none;\"><\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>Patient Information New Patient Paperwork John R. Striebel, DDS offers our patient form(s) online so they can be completed in the convenience of your own home or office. All forms are PDF files. You will need AdobeReader\u00ae to view them. If you do not already have AdobeReader\u00ae installed on your computer, Click Here\u00a0to download. Download&hellip;<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"two_page_speed":{"current_score":{"desktop_score":88,"desktop_tti":"0.7\u00a0","mobile_score":87,"mobile_tti":"3.2\u00a0","date":"30.06.2025 02:32:28 pm","status":"error_no_score"}},"footnotes":""},"class_list":["post-40","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Patient Information for John R. 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