Patient Resources22 – Summit Dental Specialty

Refer a Patient

We strive to make your visit to Summit Dental Specialty a great one. We provide the highest possible standards of care in a professional yet comfortable environment.

By referring you to our office, your dentist has shown their concern that you recieve best endodontic care here in Arizona. Out team hopes to exceed your expectations in dental care

Forms:

To save time, we invite you to download our forms below before your visit with our dental team here at Summit Dental Specialty. You can fill out the forms and bring them in with you on your scheduled visit with us or you can email them prior to your visit at contact@summitdentalspecialty.com.

Please feel free to contact us with any questions at 480.893.ENDO (3636) or to schedule your next visit.

New patients: Please download the New Patient Packet, which includes all necessary paperwork.
If you are a referring physician, please download the Referral Packet.
If you are inquiring about the list of insurances we currently accept, please refer to the Summit Insurance Listed below the downloads.

Referral Packet

New Patient Packet

Privacy Practices Acknowledgement

Alzheimer’s/Dementia

Alzheimer’s/Dementia refers to a serious loss of mental abilities such as thinking, remembering, reasoning and communicating. Dementia is not a normal part of aging. It can be difficult to know whether you or your loved one is suffering from Alzheimer’s/Dementia as the symptoms typically appear gradually (beginning with memory loss).

Saveo knows from personal and professional experience that caring for a loved one suffering from Alzheimer’s/Dementia can be physically, emotionally and mentally exhausting.

Memory loss
Disorientation
Confusion about time or place
Communication issues
Inability to read, write, speak or understand
Mood and behavior changes, such as aggressiveness, wandering or withdrawal

Cancer

Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. Not all tumors are cancerous; benign tumors do not spread to other parts of the body. Possible signs and symptoms include a lump, abnormal bleeding, prolonged cough, unexplained weight loss.

While these symptoms may indicate cancer, they may have other causes. Over 100 types of cancers affect humans. Tobacco use is the cause of about 22% of cancer deaths.

Memory loss
Disorientation
Confusion about time or place
Communication issues
Inability to read, write, speak or understand
Mood and behavior changes, such as aggressiveness, wandering or withdrawal

Multiple Sclerosis

Multiple sclerosis (MS) is a demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This damage disrupts the ability of parts of the nervous system to communicate, resulting in a range of signs and symptoms, including physical, mental, and sometimes psychiatric problems.

Specific symptoms can include double vision, blindness in one eye, muscle weakness, trouble with sensation, or trouble with coordination. MS takes several forms, with new symptoms either occurring in isolated attacks.

Memory loss
Disorientation
Confusion about time or place
Communication issues
Inability to read, write, speak or understand
Mood and behavior changes, such as aggressiveness, wandering or withdrawal

Parkinson’s

Parkinson's disease (PD) is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms generally come on slowly over time. Early in the disease, the most obvious are shaking, rigidity, slowness of movement, and difficulty with walking. Thinking and behavioral problems may also occur.

Dementia becomes common in the advanced stages of the disease. Depression and anxiety are also common occurring in more than a third of people with PD. Other symptoms include sensory, sleep, and emotional problems.

Memory loss
Disorientation
Confusion about time or place
Communication issues
Inability to read, write, speak or understand
Mood and behavior changes, such as aggressiveness, wandering or withdrawal

Stroke

A stroke is when poor blood flow to the brain results in cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. They result in part of the brain not functioning properly. Signs and symptoms of a stroke may include an inability to move or feel on one side of the body.

Signs and symptoms often appear soon after the stroke has occurred. If symptoms last less than one or two hours it is known as a transient ischemic attack (TIA) or mini-stroke. A stroke may also be associated with a headache.

Memory loss
Disorientation
Confusion about time or place
Communication issues
Inability to read, write, speak or understand
Mood and behavior changes, such as aggressiveness, wandering or withdrawal