Patient Forms

When you visit our office, our team works hard to make your dental experience as efficient as possible. We encourage you to complete our new patient forms before your first visit with Dr. [doctor_name], our friendly dentist in [city], [state]. This will save you some time at your appointment. If you have any questions, please feel free to call our dental office today. We are happy to assist you!



New Patient Special

Dr [doctor_name] and our team love welcoming new patients to our office! We are excited to provide a free cleaning with the purchase of an exam, and x-ray. To schedule your visit with our caring dentist, we invite you to call our office today at [phone]. We look forward to caring for your smile!


Financial Options

At Dr. [doctor_name]’s office, we realize how important your oral health is. That is why we offer our patients several convenient payment options to make affording our comprehensive dental services simple. Our office is in network with the following insurance companies:

  • Aetna Dental PPO
  • Assurant
  • Careington
  • Cigna PPO
  • Delta Dental
  • DentaQuest
  • Empire Blue Cross Blue Shield
  • Fidelis
  • GEHA
  • GHI Preferred
  • Guardian Dental Guard Preferred
  • Healthfirst
  • MetLife PPO
  • Oxford
  • PBA
  • Principle PPO
  • Sele-Dent
  • United Concordia
  • WellPoint
  • 1199SEIU

We also accept the following forms of payment:

  • Cash
  • Checks
  • Credit Cards (VISA, MasterCard, and Discover)
  • In-office payment plan

We encourage you to call our dentist in [city], [state], today to learn more about our financial options. We look forward to seeing you at our office soon!