Appointments

Thank you for your interest in our services. Please fill out the information below and one of our team members will contact you to schedule an appointment time. We look forward to seeing you soon.

Patients Name:
Email:
New Patient:
Yes | No
Address:
Phone:
Preferred Days:
Convenient Times:
How did you hear about our practice?:
How did you find our web site?:
Comments:



Financial/Insurance Information

Your treatment plan will include a breakdown of all applicable fees, and we will inform you of all costs before treatment is administered. Charges are payable at the time of treatment. Visa and MasterCard payments are accepted.

Please ask a member of our staff about financing options available through Care Credit and the Dental Fee Plan. We will review our payment options to accommodate your financial needs.

If special arrangements are needed, please talk to our office manager prior to receiving service.

Additionally, we will submit all insurance claims for you. We will fully attempt to help you receive full insurance benefits; however, you are personally responsible for your account, and we encourage you to contact us if your policy has not paid within 30 days.




SmithtownNew York

Now Offering

SmithtownNew York