Your First Visit

To provide our office with important information and to avoid delay in your appointment time, please complete the following:

Also, please bring the following:

  • Patient’s insurance card
  • Driver’s license or photo I.D. of the patient (Parent or Guardian’s I.D. if the patient is a minor)
  • List of current prescriptions and/or over-the-counter medication, including dose and frequency
  • Information about patient’s medical and surgical history
  • Recent x-rays, referral from your Dentist, test results or relevant records

We again thank you for choosing our office for your oral surgery needs. If you have any questions for us prior to this time, please do not hesitate to call.

Download New Patient Information Package

Patient information/Health history/Privacy practices Note: You may fill-out the forms online or print and bring them to your first appointment. If you do not wish to complete the forms prior to your appointment, you are welcome to do so in our office.

SCHEDULE A CONSULTATION

Fill out the form below and we will contact you during our working hours. If you have a dental emergency, please call 716-565-1830.

Online Registration

In order to use our Online Registration Portal, please read these instructions carefully:

You have two options on how to complete them and submit them to our office. To use either option must have an up to date PDF reader installed on your computer. We recommend Adobe Reader.

  • Click on the link below marked Online Registration Package. Our form will open up as a PDF file.
    Fill out the form on your computer and then save it to your computer.
  • You can then either print it and bring it with you or you can submit it securely through our online submission portal below. Our preference is that you send it in advance of your appointment, so we are better prepared to serve you upon your arrival.
  • If printing them out, you are done. If submitting them to us, please continue reading.
  • Once you have completed and saved the form to your computer, come back to this page and complete the submission form below.
  • You will need to enter your name, your email address, attach your registration package and you may leave a comment before submitting it to us.
  • Troubleshooting: If you are having trouble with the print or save button on the form, go to the Adobe top menu bar and click on the print or save icons. If those icons are not being displayed then go to the browser’s top menu bar and click on File. On the drop down menu click on either Save as… or Print. We recommend saving the file first before printing. If you continue to have any issues, please contact our office.

New Patient Information Package

Your Name (required)

Your Email (required)

Please attach your registration form here. *

You may also leave a message below:

Financial & Insurance

We believe firmly that financials should not be the obstacle that prevents you from having the treatment that you desire and is necessary in most cases. We are sensitive to the fact that different patients have different needs and various financial situations.

We assist you in complete confidence to find a means of making your treatment affordable with different payment options. The fees charged in this office are comparable to those charged by others in our area.

Insurance and Payment Information:

We gladly accept VISA, MasterCard, American Express, Discover, Cash and Check.

Payment plans are available through our Healthcare Financing partners:

Care Credit: www.carecredit.com 800-365-8295

Insurances Accepted:

We participate with many dental insurance companies. If you are utilizing your insurance we do collect your estimated patient portion, if any, in full on the day of service. We gladly process your insurance forms and will work with you to assure we maximize all your insurance benefits!

Please be aware that this is a courtesy of our office and that your insurance policy is a contract between you and your insurance company. We encourage you to read your insurance benefit book provided by your insurance company to better understand the specifics of your coverage.

Please bring your insurance card and driver’s license with you to your scheduled appointment; we do need to make a copy for your patient chart for verification. We do understand at times the insurance does not provide cards for dental so please have the Primary Card Holder’s information with you.

If you have questions regarding billing or which insurance plans we accept, please contact us. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.

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