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Patient Information

Important Information For You

Patient information on the effects of certain foods or herbs that may alter Warfarin activity or contain anticoagulant and antiplatelet properties.
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As part of our partnership dentistry, we want you to have all necessary information from requesting an appointment to financing your services to helping you understand your dental procedures. Please click on subjects below:

State-of-the-Art equipment, knowledge, and experienced dental professionals make a successful combination.

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We want to make sure you maximize your potential benefits. We will help you navigate the often confusing world of dental insurance. We accept most insurance plans and will be happy to file the paperwork with your insurance carrier for you, and we even offer a pre-treatment estimate. Please call our office at 281-376-9246 for information on your specific insurance plan.
Medical Billing
Did you know that many dental procedures can be filed with medical insurance as well as dental insurance? To help patients cover the costs of treatment, Councill and Glass Dental Group can now bill both dental insurance and medical insurance simultaneously, helping our patients pay even less for certain procedures.. We are familiar with medical insurance and as a courtesy we will file the necessary papers with your insurance company. Medical billing is especially helpful for procedures such as:
  • Surgical services
  • TMJ and TMD Splint Therapy
  • Oral Surgery
  • Oral Cancer
  • Congenitally missing teeth
  • Sleep Apnea Treatment
  • Accidents and Trauma
For more information, and to see if your treatment qualifies for medical billing, talk to our friendly and knowledgeable office staff today.

Patient Forms

If you are a new patient at Councill and Glass Dental Group, please print out the forms below and bring them with you to your first appointment. Instead of spending a lot of time in the waiting room filling out forms, you can see your Cypress, TX, dentist much sooner. There are three forms to choose from: New Patient Forms, TMJ Patient Forms, and Wisdom Teeth Forms. The New Patient forms and Wisdom Teeth forms will simply need to be printed and filled out. The TMJ form can actually be filled out and submitted online prior to your visit.

Our questionnaire consists of 5 documents. To complete a document, simply fill out the fields with the requested information. While most of the fields are optional, certain fields, marked by asterisks, must be completed. When you have completed a document please review your entry, click the Submit button to move to the next document. Please don't use your browser's Back or Forward buttons. Use of these buttons may undo or redo your recent actions and may result in errors.

Please note that the information you will submit will be encrypted for your protection and goes directly to our office. We appreciate the time that you will spend providing the information helping us prepare for your visit.


New patient forms are emailed to new patients as first-time appointments are made. Please complete the form electronically and send to our office prior to your first visit. If you cannot complete the form prior to your first visit, please arrive at least 15 minutes before your scheduled appointment and we will help you complete it in the office.

If you are an existing patient and need to update your contact information, insurance, etc., please call or email our office and we can send a Patient Information Update form to you via email.

Please note that the electronic forms you submit are sent directly to our office and are encrypted for your protection. We appreciate the time that you will spend providing the information helping us to prepare for your visit.

Thank you and please call our office (281) 376-9246 or email to if you have any questions.