• 129 Bellevue Ave.
  • Penndel, PA 19047
  • 215-757-2440

Patient Resources & Insurance

Patient Forms

Here are some forms that you will need to have completed prior to your first visit. Please print them, fill out the information and bring the completed forms with you. If you prefer, all but the HIPAA form can be completed on the computer. You can enter your information, save the file with a name of your choice and email these forms to our office or print them out and bring with you. When you come in to the office for your appointment, we will have your emailed forms available for signature. Thank you.

Patient Registration Form
Medical Health History Form
Dental History
HIPAA Notice
Head Health History

Financial Information

In our office we believe it is necessary to fit the treatment that you need into your lifestyle. Payment is expected at the time dental treatments are performed. Payment plans can be arranged with our office when extensive dental care is needed. We have several financial options available and are pleased to discuss them with you when needed.

One of the financial options we offer is with CareCredit. You can click on the link to take you directly to the enrollment page.


We understand that people have busy lifestyles that can change at the last minute. Even we can run late due to emergency patients upsetting our carefully planned schedule. We try our best to run on time and we appreciate our patients who give us the courtesy of arriving on time as well. We do our utmost to notify you by phone and/or e-mail before you arrive if we do run into delays. We request and appreciate your notifying the office if you cannot make your appointment on time. Depending on the amount of time you will be late, we may ask you to reschedule your appointment. Lateness occurring multiple times or several last-minute cancellations will show us that your personal schedule does not allow you to reserve appointments due to how hectic your lifestyle is and we will try to work out with you alternative ways you can still get in to see us. If you do need to cancel, we request notification as early as possible, at least 24 hours prior to your appointment.