Kingston Dental Practice


Patient Resources

We are dedicated to offering our patients the best service possible at each visit. To ensure your visit is stress free, we have provided the following information to help in the preparation for your visit.

  • Patient forms
  • Payment information
  • FAQ
  • My Account
Patient forms

In an effort to reduce wait time and make dental appointments as stress free as possible we encourage patients to complete their forms online. Below you will find all of the forms necessary to get the most up to date information into our system.

Adobe Acrobat is required to retrieve our documents, if you do not have Adobe you can download it free.

All of our patient forms are digital and can be accessed through the patient portal. If you do not have access to our patient portal, please call our office at 865-717-3586 and we will set it up immediately. Thank you!

If you are transferring from another dental office please download our records release form and have your records mailed, faxed, or emailed to our office prior to your appointment.

Payment information

Kingston Dental Plan for Patient Without Insurance

Low Cost Dental Plan

Receive all the rewards of dental insurance without the limitations, costs, and restrictions.



Individual + Spouse


Additional family members

(up to age 26)


Please ask about Periodontal Plan pricing

This is not insurance but a membership payment plan provided by KDP PLLC and is not transferable to other dental offices. Payment for any treatment is due at the time of service. Yearly dues must be current in order to receive plan benefits. This plan may not be combined with any other discounts. It is solely the patient’s responsibility to schedule and keep their appointments. No refunds will be provided for dues paid under any circumstances, including failure to schedule and maintain appointments. Yearly dues and fees for dental services may change at any time. Payment management services will be managed by iCare Financial®.


Our staff gladly processes insurance claims and will verify your benefits as a convenience to you. Please bring the necessary information with you on your first visit. We are happy to bill to all traditional insurance plans, and for your convenience, we are also preferred providers for the insurance plans listed below. If your insurance is not listed that doesn't mean we do not accept it! Give our office a call and we will answer all your insurance questions.




Blue Cross Blue Shield


Companion Life

Cover Kids

Delta Dental Premier

Delta Dental PPO




Principal Financial

Lincoln Financial


DentaQuest (Tenncare)


For single visit procedures, our staff will determine your out-of-pocket expense based on your insurance plan and payment is expected that day. For multi visit procedures, our staff will determine your out-of-pocket expense and payment can be split among the number of visits it takes to complete your treatment. Our determination is only an estimate based on the limited information your insurance company provides, therefore it is not uncommon to receive a statement for the difference  you may owe. Any over-payments will be used as credit on your account.


Are you accepting new patients?​

Yes, we are accepting new patients. Call today to make an appointment!

How often should I see the dentist? 

Children, teens, and adults should all see the dentist for a regular checkup at least once every six months. Patients who are at a greater risk for oral cancer or gum disease may be required to see the dentist more than just twice a year. You doctor will help determine how often you should visit the dentist for regular checkups.

What do I need to bring to my first visit?​

Please bring your insurance cards, medical records from previous dentist, and any applicable custody papers (if the patient is under the age of 18).

Why are there so many questions on this Health History?​

Each of the questions asked on the medical history sheet have specific items that can easily have an effect on the delivery of dental treatment. The body is all connected. That medication you take for some other part of the body can be important for today’s filling or extraction or even cleaning plans.

My Account

For existing patients, Managing your health information just got easier! With XLDent Patient portal you can check our account at your convenience 24 hours a day. To access your account, you must be an existing patient and have a valid email address. Please contact our office at 865-717-3586 to set up your account.

The benefits of our patient portal include but are not limited to:

Completing forms for yourself or the entire family​

Viewing scheduled appointments​

Viewing proposed treatment plans

​Viewing treatment history

​Accessing billing statements​

Making payments online ​

Kingston Dental Practice

© 2021 by Kingston Dental Practice. All rights reserved.