• New patients
• Current and new patients

For New Patients
New patients often have lots of questions. If you have any questions or concerns, please contact us.

Release of Records Form
New patients have a number of forms to fill out prior to seeing the dentist or hygienist. The first form to fill out is the release of records, included here as a PDF. Please fill out the release of records form and send to your previous dental provider or send it to us and we will request your records.

• Release of Records (for new patients only)

• Online Forms (all patients)


• Please note it may take up to two full business days for a your login access to be approved - access is contingent on arranging your first appointment. Also note you do not need to print these forms, just be sure to click the "Submit" button as you go through the forms.

To schedule an appointment, please contact us.

Insurance
We are able to help process any insurance paperwork, however we do not accept all forms of insurance. Please see the list of insurance carriers we participate with below. If you do not have any dental insurance, please note that payment is due upon completion of services unless previous arrangements have been made with our office. Please contact our front desk staff should you have any questions regarding our policy.

Insurance carriers we participate with include:

• Anthem
• Assurance
• Cigna (PPO only)
• Delta Dental
• Empire
  (some, please contact our front desk staff)
• Guardian
• MetLife
• Principal
• Solstice (PPO only)
• United Concordia
• United Healthcare

Credit cards accepted, in the office and by phone:

• VISA
• MasterCard
• American Express
• Discover
• CareCredit

Cancellations - Attention All Patients

FAILED APPOINTMENT FEE POLICY

WE REQUIRE 24 HOURS NOTICE OF CANCELLATION TO AVOID A FAILED APPOINTMENT FEE OF $60.

PLEASE DO NOT CALL ON THE WEEKEND TO CANCEL AN APPOINTMENT AS THE OFFICE IS CLOSED AND WE CANNOT FILL THAT TIME SLOT. WE CLOSE AT NOON ON FRIDAY.

THANK YOU,
POLASKI DENTAL GROUP