Prior to your appointment, please fill out our patient health packet.
Patients who carry dental insurance understand that your insurance claims will be processed for you. As a
result, your patient portion is due at the time of service. Dr. Weaver and Staff are not accountable for what your
insurance does or does not pay towards your balance. Ultimately, all charges are the patient's responsibility
regardless of the insurance benefits. We do offer CareCredit for financing if needed.
A finance fee of 10% will be applied to unpaid balances on all accounts exceeding 30 days after insurance
The practice depends on your commitment to making your appointments. A 48-hour notice is requested if you
have to cancel or change your appointment time. Appointments canceled with less than a 24-hour notice may be subject to a broken appointment fee.
HIPPA is a federal law developed to provide a standard for the protection of your health information. The
purpose of the Notice of Privacy Practice is to explain how Eastpark Dental may use or disclose your health
care information. The notice also explains the rights that you are guaranteed under HIPPA regulations.
Signing below indicates that you have received the Notice of Privacy Practice. If you have any questions, please
let us know.
Dr. Karl Weaver
5100 Eastpark Blvd, Suite 110
Madison, WI 53718
Monday: 7:30am – 5:30pm
Tuesday: 7:30am – 5:30pm
Wednesday: 7:30am – 5:30pm
Thursday: 7:30am – 4:30pm
Friday: 8:00am – 11:00am (Admin Only)
Please feel free to send in your appointment request.
We will reach out to you with a confirmation or an alternate date.