How to Use Our Forms:

Click the button below each form to download or print. You can either print the form and fill it out by hand, or fill it out on your device and download and email it.  If you complete your form digitally, fill out the form, then click the print button in the upper right-hand corner of your screen,  select “Save as PDF” and email the document to


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.