Patient Forms

New Patient Forms

Please print out the forms below and fill out to bring in to your first appointment. Thank you and we are looking forward to seeing you soon.

If you have any questions about enamel reshaping and you live in or around Exton, give us a call today!

Other Patient Forms

PAYMENT OPTIONS

We are always available to help you obtain the benefits to which you are entitled.

We accept cash, check, Visa, MasterCard, American Express and Discover. We also offer CareCredit, a personal line of credit for healthcare treatments and procedures for your entire family.

CareCredit Logo

INSURANCE

We are an in-network provider for Cigna.

We will handle the filing of all other insurances as an out of network provider. Most insurance companies will assign the benefits (send the reimbursement check to the dental office). If there is a difference between the insurance reimbursement and the office fee, the patient is responsible for the balance. All insurance plans reimbursement schedules vary, we will do our best to estimate the patient portion of treatment.