Forms | Lipkowitz Dental Associates Gloucester MA

How to Fill Out Our Forms:

Use the button below this form to open it, from there you can print it and fill out by hand or do it digitally. If done digitally, fill out the form, then click the print button in the upper right hand of your screen. You can either print as normal and bring it into our office, or change it to “Print as PDF” and email the document to us! Info@Lipkowitzdental.com

New Patient Form

Health History Form

Dental Questionnaire

Dental Consent Form

Insurance

Currently, we are in-network providers for:

Dental Blue from Blue Cross
Delta Dental Premier
Delta Dental PPO plus Premier
We also accept CareCredit and provide all required documentation to qualify dental expenditures out of your FSA (Flexible Spending Account).

For all other insurances, we expect payment from you at the time of your visit and we will submit all claims on your behalf for reimbursement directly to you.