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
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.