Adult Medical History 2015-04-07To save time on the day of your appointment, please fill out these forms and bring them with you:
Pediatric Dental Patient Forms:
- Pediatric Patient Registration Form
- Pediatric Medical History Form
- Notice of Privacy Practices Acknowledgement
Adult DENTAL PATIENT Forms:
Anesthesia PATIENT FORMS:
- Anesthesia Patients - Patient Registration Form
- Anesthesia Patients - Medical History Form
- Anesthesia Patients - Physician Consultation
- Anesthesia Patients - Pre Anesthesia Instructions
- Anesthesia Patients - Post Anesthesia Instructions
- Anesthesia Patients - Notice of Privacy Practices Acknowledgment
These files are in PDF format. If you do not have Adobe® Reader® on your computer, you can download it for free by clicking here or on the Get Adobe Reader icon.
To schedule an appointment, please call (516) 487-8110 for our office. A pediatric dentist and general dentist are on-call 24 hours-a-day, 7 days-a-week.
If you have an emergency after office hours, please call (516) 674-5973. Our emergency answering service will contact the appropriate dentist on-call, depending on if the emergency is for an adult or a child. Our dentists will contact you after they are notified of your emergency.
8:00am - 1:00pm
*July and August 8:00am - 12:00pm
Health Insurance Plans
Filing of insurance forms by the practice is done as a courtesy to our patients. The responsible person shown in our records, not the insurance carrier, is financially liable for payment.
Just as we are committed to providing excellent dental care, we are concerned with making it affordable to you. By reducing costly billing procedures and requesting payment at the time services are rendered, we can keep our costs down and pass the savings on to our patients. For your convenience, we accept MasterCard, VISA, AMEX, personal checks and cash. For extensive treatment, we are pleased to offer CareCredit, a flexible payment option offered to our patients. Ask us for details.